Jadhao Manish, Surana Kuntal, Shewale Vijay, Raut Chaitanya Hemant, Shah Vaibhav, Mishra Prashant, Khandekar Jayant
Department of Cardiovascular and Thoracic Surgery, Lokmanya Tilak Municipal Medical College and General Hospital, Mumbai, India.
Kardiochir Torakochirurgia Pol. 2020 Dec;17(4):193-197. doi: 10.5114/kitp.2020.102337. Epub 2021 Jan 15.
Constrictive pericarditis (CP) usually presents as a result of chronic fibrous pericardial thickening and calcification of the pericardium which causes reduced cardiac output. Despite the lack of prospective studies comparing the different therapeutic strategies, surgical pericardiectomy is a valuable treatment under most circumstances.
We analyzed our records to highlight the predictors of morbidity and mortality of pericardiectomy and also short-term surgical outcome of the same procedure in a single center.
We carried out a comprehensive retrospective analysis of the records of patients who underwent surgery for CP at our institute between 2013 and 2018. 30 patients underwent isolated pericardiectomy. All patients underwent median sternotomy and total pericardiectomy without the use of cardiopulmonary bypass. Pre-operative, intra-operative and post-operative characteristics were noted.
Fifteen patients had a history of pulmonary tuberculosis. The majority of the patients presented with NYHA grade III or IV. 60% of the patients were male. The preoperative mean central venous pressure was 24 ±9 mm Hg and decreased to 9 ±5 mm Hg after surgery. The 30-day mortality was 6.66% (2/30). Morbidity was mainly due to low-cardiac output syndrome ( = 4). A total of 26 patients had significant improvement in their NYHA status.
Although pericardiectomy for CP remains associated with some operative mortality, the short-term outcome is favorable, and surgical treatment is able to improve the functional class in the majority of survivors.
缩窄性心包炎（CP）通常是由于慢性纤维性心包增厚和心包钙化导致心输出量减少所致。尽管缺乏比较不同治疗策略的前瞻性研究，但在大多数情况下，手术心包切除术是一种有价值的治疗方法。
我们分析了我们的记录，以突出心包切除术发病率和死亡率的预测因素，以及同一手术在单一中心的短期手术结果。
我们对2013年至2018年在我院接受CP手术的患者记录进行了全面的回顾性分析。30例患者接受了单纯心包切除术。所有患者均接受正中胸骨切开术和全心包切除术，未使用体外循环。记录术前、术中和术后特征。
15例患者有肺结核病史。大多数患者表现为纽约心脏协会（NYHA）III级或IV级。60%的患者为男性。术前平均中心静脉压为24±9mmHg，术后降至9±5mmHg。30天死亡率为6.66%（2/30）。发病率主要归因于心输出量低综合征（=4）。共有26例患者的NYHA状态有显著改善。
尽管CP的心包切除术仍与一定的手术死亡率相关，但短期结果良好，手术治疗能够改善大多数幸存者的功能分级。
