Korean J Thorac Cardiovasc Surg.  2017 Feb;50(1):22-29. 10.5090/kjtcs.2017.50.1.22.

The Importance of Complete Pericardiectomy and the Role of the Apical Suction Device in Chronic Constrictive Pericarditis

• Kim SY
• Na KJ
• Kim KH

• KMID: 2368428
• DOI: http://doi.org/10.5090/kjtcs.2017.50.1.22

Abstract

BACKGROUND
The aim of this study was to analyze the preoperative attributes and clinical impacts of complete pericardiectomy in chronic constrictive pericarditis.
METHODS
A total of 26 patients were treated from January 2001 to December 2013. The pericardium was resected as widely as possible. When excessive bleeding or hemodynamic instability occurred intraoperatively, a cardiopulmonary bypass (CPB; n=3, 11.5%) or an apical suction device (n=8, 30.8%) was used. Patients were divided into 2 groups: those who underwent ≥ 80% resection of the pericardium (group A, n=18) and those who underwent <80% resection of the pericardium (group B, n=8).
RESULTS
The frequency of CPB use was not significantly different between groups A and B (n=2, 11.1% vs. n=1, 12.5%; p=1.000). However, the apical suction device was more frequently applied in group A than group B (n=8, 30.8% vs. n=0, 0.0%; p=0.031). The postoperative New York Heart Association functional classification improved more in group A (p=0.030). Long-term follow-up echocardiography also showed a lower frequency of unresolved constriction in group A than in group B (n=1, 5.60% vs. n=5, 62.5%; p=0.008).
CONCLUSION
Patients with chronic constrictive pericarditis demonstrated symptomatic improvement through complete pericardiectomy. Aggressive resection of the pericardium may correct constrictive physiology and an apical suction device can facilitate the approach to the posterolateral aspect of the left ventricle and atrioventricular groove area without the aid of CPB.

Keyword

Pericardiectomy; Constrictive pericarditis; Cardiopulmonary bypass

MeSH Terms

Cardiopulmonary Bypass
Classification
Constriction
Echocardiography
Follow-Up Studies
Heart
Heart Ventricles
Hemodynamics
Hemorrhage
Humans
Pericardiectomy*
Pericarditis, Constrictive*
Pericardium
Physiology
Suction*