Kőszegi Andrea, Kapus Gábor, Szabolcs Zoltán, Horkay Ferenc, Hüttl Tivadar, Fazekas Levente, Daróczi László, Pólos Miklós, Koppányi Ádám, Németh Endre, Apor Astrid, Vágó Hajnalka, Merkely Béla, Hartyánszky István
1 Semmelweis Egyetem, Általános Orvostudományi Kar, Városmajori Szív- és Érgyógyászati Klinika, Szívsebészeti Profil Budapest, Városmajor u. 68., 1122 Magyarország.
2 Semmelweis Egyetem, Általános Orvostudományi Kar, Aneszteziológiai és Intenzív Terápiás Klinika Budapest Magyarország.
Orv Hetil. 2022 Mar 6;163(10):393-399. doi: 10.1556/650.2022.32378.
Introduction: Constrictive pericarditis is a disease caused by a chronic inflammatory process, which is characterized by the pericardium’s loss of flexibility, inhibiting the function of the heart, ultimately causing heart failure. The only definitive therapy is surgical. Total pericardiectomy, which is the most common surgical approach, is a lengthy procedure with up to 18% operative risk, and it often requires the use of cardiopulmonary bypass. Objective: The evaluation of the effectiveness, results and possible advantages of a surgical technique, “turtle cage” pericardiectomy, which is described in the literature, although rarely used, mainly in addition to conventional pericardiectomy. Method: Between 2008 and 2021, we performed 33 “turtle cage” procedures on patients with constrictive pericarditis in our Institute. We compared the results of the 30-day postoperative period with internationally published data from multiple sources. Results: Based on intraoperative findings, the procedure was successful in all cases, there were no instances when the use of cardiopulmonary bypass was required (0%). During the 33 procedures, we lost 1 patient (3%), reoperation was necessary for postoperative bleeding in 1 case (3%), and postoperative dialysis was necessary in 4 cases (12.1%). These results are comparable to those published by high-volume centres, and significantly better than those of one of the European centres published. Conclusion: The “turtle cage” pericardiectomy, as performed in our Institute, is suitable for the treatment of constrictive pericarditis on its own. With its use, we were able to minimize the use of cardiopulmonary bypass and the operative risk. Our results with this technique are comparable to those of the high-volume, highly experienced centres. Orv Hetil. 2022; 163(10): 393–399.
缩窄性心包炎是一种由慢性炎症过程引起的疾病，其特征是心包失去弹性，抑制心脏功能，最终导致心力衰竭。唯一确定的治疗方法是手术。全心包切除术是最常见的手术方法，是一个漫长的过程，手术风险高达18%，并且通常需要使用体外循环。目的：评估一种手术技术——“龟笼”心包切除术的有效性、结果及可能的优势。该技术虽在文献中有描述，但很少使用，主要是作为传统心包切除术的辅助方法。方法：2008年至2021年期间，我们在本研究所对33例缩窄性心包炎患者实施了“龟笼”手术。我们将术后30天的结果与来自多个来源的国际发表数据进行了比较。结果：根据术中发现，该手术在所有病例中均成功，无需使用体外循环（0%）。在这33例手术中，我们有1例患者死亡（3%），1例因术后出血需要再次手术（3%），4例需要术后透析（12.1%）。这些结果与大容量中心发表的结果相当，且明显优于欧洲某一中心发表的结果。结论：我们研究所实施的“龟笼”心包切除术本身适用于治疗缩窄性心包炎。通过使用该技术，我们能够最大限度地减少体外循环的使用和手术风险。我们使用该技术的结果与大容量、经验丰富的中心相当。《匈牙利医学周报》。2022年；163(10):393–399。
