Benjamin Santhosh Regini, Mohammad Aamir, Shankar Ravi, Kuruvilla Korah Thomas, Philip Madhu Andrew, Thankachen Roy, Gnanamuthu Birla Roy, Kesavan Premprasath
The Department of Cardiothoracic Surgery, The Christian Medical College, Tamil Nadu, Vellore, 632004 India.
Indian J Thorac Cardiovasc Surg. 2022 May;38(3):241-250. doi: 10.1007/s12055-021-01313-y. Epub 2022 Feb 5.
Tuberculosis (TB) is the commonest cause of chronic constrictive pericarditis (CCP) in India, unlike in the western countries. Pericardiectomy is the treatment of choice for CCP. Surgery in TB CCP is considerably more difficult than it is for other etiologies. The role of TB as an independent predictor for adverse surgical outcomes had not been properly evaluated in the Indian scenario. Hence, the aim of this study was to retrospectively analyze our results of surgery for CCP and the pre-operative factors that influenced post-operative outcomes.
The data of all adult patients who underwent pericardiectomy for CCP, between the years 2009 and 2020, maintained in a live database in our institute, were retrieved and analyzed.
There were 124 patients in the study. The average age was 32 years. The male to female ratio was 3:1. TB was the commonest cause of CCP, identified in 64 (51.6%) patients. Complete anterior pericardiectomy (CAP) was possible in 122 (98.3%) patients. All the patients had significant drop in their central venous pressure (CVP) (10.25 ± 3.47 mmHg) after surgery. The operative time ( = 0.008), intra-operative blood loss ( = 0.02), intensive care unit (ICU) stay ( = 0.03), and hospital stay ( = 0.028) were significantly higher in the TB group. Apart from TB, the other pre-operative variables that predicted adverse outcomes were male sex, presence of pleural effusion or ascites, and advanced New York Heart Association (NYHA) class. There were 7 (5.6%) post-operative complications and 3 (2.4%) in-hospital deaths.
The high incidence of TB CCP makes a pericardiectomy in developing countries technically more challenging resulting in increased operative time, more blood loss, and prolonged ICU and hospital stay, but did not affect in-hospital mortality or morbidity.
与西方国家不同，在印度，结核病（TB）是慢性缩窄性心包炎（CCP）最常见的病因。心包切除术是CCP的首选治疗方法。结核性CCP的手术比其他病因的手术要困难得多。在印度的情况下，结核作为不良手术结果的独立预测因素的作用尚未得到充分评估。因此，本研究的目的是回顾性分析我们的CCP手术结果以及影响术后结果的术前因素。
检索并分析了2009年至2020年间在我们研究所的实时数据库中记录的所有因CCP接受心包切除术的成年患者的数据。
本研究共有124例患者。平均年龄为32岁。男女比例为3:1。结核是CCP最常见的病因，64例（51.6%）患者确诊为此病因。122例（98.3%）患者可行完全前心包切除术（CAP）。所有患者术后中心静脉压（CVP）均显著下降（10.25±3.47 mmHg）。结核组的手术时间（=0.008）、术中失血量（=0.02）、重症监护病房（ICU）停留时间（=0.03）和住院时间（=0.028）明显更长。除结核外，其他预测不良结果的术前变量为男性、存在胸腔积液或腹水以及纽约心脏协会（NYHA）心功能分级较高。术后有7例（5.6%）并发症，3例（2.4%）住院死亡。
结核性CCP的高发病率使得发展中国家的心包切除术在技术上更具挑战性，导致手术时间延长、失血增多、ICU和住院时间延长，但不影响住院死亡率或发病率。
