Document Type : Review Article
Author
Prince Talal Street, Al Mana General Hospital, Cardiothoracic department
Abstract
Chronic constrictive pericarditis results in the signs and symptoms of heart failure due to the chronic compression of the myocardium. When the pericardium becomes thickened and fibrosed, surgery is the sole curative management strategy. Surgery leads to an improvement in functional status and survival, but it is associated with significant mortality and morbidity. Over the years, the surgical approach to this pathology has largely remained unchanged, but there has been a shift in the etiological mechanism of constrictive pericarditis from predominantly tuberculous to post-cardiac surgery and idiopathic pathologies. This review offers an overview of the surgical management of constrictive pericarditis.
Keywords
1- Rodriguez ER, Tan CD. Structure and Anatomy of the Human Pericardium. Prog Cardiovasc Dis 2017; 59(4): 327-40.
https://doi.org/10.1016/j.pcad.2016.12.010
2- Barbetakis N, Xenikakis T, Paliouras D, Asteriou C, Samanidis G, Kleontas A, et al., Pericardiectomy for radiation-induced constrictive pericarditis. Hellenic J Cardiol 2010; 51(3): 214-8.
3- Mutyaba AK, Balkaran S, Cloete R, du Plessis N, Badri M, Brink J, et al., Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: causes and perioperative outcomes in the HIV era (1990-2012). J Thorac Cardiovasc Surg 2014; 148(6): 3058-65. e1.
https://doi.org/10.1016/j.jtcvs.2014.07.065
4- Pon A. Rajarajan. Clinical and surgical outcomes of pericardiectomy done by total anterolateral thoracotomy. IAIM 2019; 6(5): 22-6.
5- Murashita T, Schaff HV, Daly RC, Oh JK, Dearani JA, Stulak JM, et al., Experience with Pericardiectomy for Constrictive Pericarditis Over Eight Decades. Ann Thorac Surg 2017; 104(3): 742-50.
https://doi.org/10.1016/j.athoracsur.2017.05.063
6- Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al., Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg 2006; 81(2): 522-9.
https://doi.org/10.1016/j.athoracsur.2005.08.009
7- Harrington SW. Chronic Constrictive Pericarditis: Partial Pericardiectomy and Epicardiolysis in Twenty-Four Cases. Ann Surg 1944; 120(4): 468-85.
https://doi.org/10.1097/00000658-194412040-00005
8- Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al., Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004; 43(8): 1445-52.
https://doi.org/10.1016/j.jacc.2003.11.048
9- McCaughan BC, Schaff HV, Piehler JM, Danielson GK, Orszulak TA, Puga FJ, et al., Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg 1985; 89(3): 340-50.
https://doi.org/10.1016/S0022-5223(19)38783-5
10- Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al., Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg 2006; 81(2): 522-9.
https://doi.org/10.1016/j.athoracsur.2005.08.009
11- Avgerinos D, Rabitnokov Y, Worku B, Neragi-Miandoab S, Girardi LN. Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis. J Card Surg 2014; 29(4): 434-8.
https://doi.org/10.1111/jocs.12344
12- Cho YH, Schaff HV, Dearani JA, Daly RC, Park SJ, Li Z, et al., Completion pericardiectomy for recurrent constrictive pericarditis: importance of timing of recurrence on late clinical outcome of operation. Ann Thorac Surg 2012; 93(4): 1236-40. https://doi.org/10.1016/j.athoracsur.2012.01.049
13- Nataf P, Cacoub P, Dorent R, Jault F, Bors V, Pavie A, et al., Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg 1993; 7(5): 252-5; discussion 255-6.
https://doi.org/10.1016/1010-7940(93)90213-U
14- Vistarini N, Chen C, Mazine A, Bouchard D, Hebert Y, Carrier M, et al., Pericardiectomy for Constrictive Pericarditis: 20 Years of Experience at the Montreal Heart Institute. Ann Thorac Surg 2015; 100(1): 107-13.
https://doi.org/10.1016/j.athoracsur.2015.02.054
15- Hemmati P, Greason KL, Schaff HV. Contemporary Techniques of Pericardiectomy for Pericardial Disease. Cardiol Clin 2017; 35(4): 559-66. https://doi.org/10.1016/j.ccl.2017.07.009
16- Chowdhury UK, Narag R, Malhotra P, Choudhury M, Choudhury A, Singh, Sarvesh P. Indications, timing and techniques of radical pericardiectomy via modified left anterolateral thoracotomy (UKC’s modification) and total pericardiectomy via median (Holman and Willett) without cardiopulmonary bypass. J Prac Cardiovasc Sci 2016; 2: 17-27. https://doi.org/10.4103/2395-5414.182999
17- Choi MS, Jeong DS, Oh JK, Chang SA, Park SJ, Chung S. Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population. J Cardiothorac Surg 2019; 14(1): 32.
https://doi.org/10.1186/s13019-019-0845-7
18- Góngora E, Dearani JA, Orszulak TA, Schaff HV, Li Z, Sundt TM. Tricuspid regurgitation in patients undergoing pericardiectomy for constrictive pericarditis. Ann Thorac Surg 2008; 85(1): 163-70; discussion 170-1. https://doi.org/10.1016/j.athoracsur.2007.06.051
19- Szabó G, Schmack B, Bulut C, Soós P, Weymann A, Stadtfeld S, et al., Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg 2013; 44(6): 1023-8; discussion 1028. https://doi.org/10.1093/ejcts/ezt138
20- Ni Y, von Segesser LK, Turina M. Futility of pericardiectomy for post irradiation constrictive pericarditis? Ann Thorac Surg 1990; 49(3): 445-8. https://doi.org/10.1016/0003-4975(90)90252-2
21- Karram T, Rinkevitch D, Markiewicz W. Poor outcome in radiation-induced constrictive pericarditis. Int J Radiat Oncol Biol Phys 1993; 25(2): 329-31.https://doi.org/10.1016/0360-3016(93)90356-Z
22- Buyukbayrak F, Aksoy E, Dedemoglu M, Kirali K, Alp HM. Pericardiectomy for treatment of neoplastic constrictive pericarditis. Asian Cardiovasc Thorac Ann 2014; 22(3): 296-300. https://doi.org/10.1177/0218492313484317
23- Gillaspie EA, Dearani JA, Daly RC, Greason KL, Joyce LD, Oh J, et al., Pericardiectomy After Previous Bypass Grafting: Analyzing Risk and Effectiveness in this Rare Clinical Entity. Ann Thorac Surg 2017; 103(5): 1429-33. https://doi.org/10.1016/j.athoracsur.2016.08.087
24- Yunfei L, Tao L, Yongjun Q. Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach. J Cardiothorac Surg 2019; 14(1): 152.
https://doi.org/10.1186/s13019-019-0978-8
25- Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart 2018; 104(9): 725-731. doi: 10.1136/heartjnl-2017-311683.
26- Cinar B, Enc Y, Goksel O, Cimen S, Ketenci B, Teskin O, et al. Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy. Int J Tuberc Lung Dis 2006; 10(6): 701-6.
27- Peset AM, Martí V, Cardona M, Montiel J, Guindo J, de Rozas JD. Outcome of Pericardiectomy for Chronic Constrictive Pericarditis. Rev Esp Cardiol 2007; 60(10): 1097-101. https://doi.org/10.1157/13111243
28- George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, Conte JV. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg 2012; 94(2): 445-51.
https://doi.org/10.1016/j.athoracsur.2012.03.079
29- Biçer M, Özdemir B, Kan İ, Yüksel A, Tok M, Şenkaya I. Long-term outcomes of pericardiectomy for constrictive pericarditis. J Cardiothorac Surg 2015; 10: 177. https://doi.org/10.1186/s13019-015-0385-8
30- Nozohoor S, Johansson M, Koul B, Cunha-Goncalves D. Radical pericardiectomy for chronic constrictive pericarditis. J Card Surg 2018; 33(6): 301-7.https://doi.org/10.1111/jocs.13715
31- Gillaspie EA, Stulak JM, Daly RC, Greason KL, Joyce LD, Oh J, et al., A 20-year experience with isolated pericardiectomy: Analysis of indications and outcomes. J Thorac Cardiovasc Surg 2016; 152(2): 448-58.
https://doi.org/10.1016/j.jtcvs.2016.03.098
32- Zhu P, Mai M, Wu R, Lu C, Fan R, Zheng S. Pericardiectomy for constrictive pericarditis: single-center experience in China. J Cardiothorac Surg 2015; 10: 34.https://doi.org/10.1186/s13019-015-0237-6
33- Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al., Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999; 100(13): 1380-6. https://doi.org/10.1161/01.CIR.100.13.1380
https://doi.org/10.1016/j.pcad.2016.12.010
2- Barbetakis N, Xenikakis T, Paliouras D, Asteriou C, Samanidis G, Kleontas A, et al., Pericardiectomy for radiation-induced constrictive pericarditis. Hellenic J Cardiol 2010; 51(3): 214-8.
3- Mutyaba AK, Balkaran S, Cloete R, du Plessis N, Badri M, Brink J, et al., Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: causes and perioperative outcomes in the HIV era (1990-2012). J Thorac Cardiovasc Surg 2014; 148(6): 3058-65. e1.
https://doi.org/10.1016/j.jtcvs.2014.07.065
4- Pon A. Rajarajan. Clinical and surgical outcomes of pericardiectomy done by total anterolateral thoracotomy. IAIM 2019; 6(5): 22-6.
5- Murashita T, Schaff HV, Daly RC, Oh JK, Dearani JA, Stulak JM, et al., Experience with Pericardiectomy for Constrictive Pericarditis Over Eight Decades. Ann Thorac Surg 2017; 104(3): 742-50.
https://doi.org/10.1016/j.athoracsur.2017.05.063
6- Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al., Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg 2006; 81(2): 522-9.
https://doi.org/10.1016/j.athoracsur.2005.08.009
7- Harrington SW. Chronic Constrictive Pericarditis: Partial Pericardiectomy and Epicardiolysis in Twenty-Four Cases. Ann Surg 1944; 120(4): 468-85.
https://doi.org/10.1097/00000658-194412040-00005
8- Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al., Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol 2004; 43(8): 1445-52.
https://doi.org/10.1016/j.jacc.2003.11.048
9- McCaughan BC, Schaff HV, Piehler JM, Danielson GK, Orszulak TA, Puga FJ, et al., Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg 1985; 89(3): 340-50.
https://doi.org/10.1016/S0022-5223(19)38783-5
10- Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al., Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg 2006; 81(2): 522-9.
https://doi.org/10.1016/j.athoracsur.2005.08.009
11- Avgerinos D, Rabitnokov Y, Worku B, Neragi-Miandoab S, Girardi LN. Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis. J Card Surg 2014; 29(4): 434-8.
https://doi.org/10.1111/jocs.12344
12- Cho YH, Schaff HV, Dearani JA, Daly RC, Park SJ, Li Z, et al., Completion pericardiectomy for recurrent constrictive pericarditis: importance of timing of recurrence on late clinical outcome of operation. Ann Thorac Surg 2012; 93(4): 1236-40. https://doi.org/10.1016/j.athoracsur.2012.01.049
13- Nataf P, Cacoub P, Dorent R, Jault F, Bors V, Pavie A, et al., Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg 1993; 7(5): 252-5; discussion 255-6.
https://doi.org/10.1016/1010-7940(93)90213-U
14- Vistarini N, Chen C, Mazine A, Bouchard D, Hebert Y, Carrier M, et al., Pericardiectomy for Constrictive Pericarditis: 20 Years of Experience at the Montreal Heart Institute. Ann Thorac Surg 2015; 100(1): 107-13.
https://doi.org/10.1016/j.athoracsur.2015.02.054
15- Hemmati P, Greason KL, Schaff HV. Contemporary Techniques of Pericardiectomy for Pericardial Disease. Cardiol Clin 2017; 35(4): 559-66. https://doi.org/10.1016/j.ccl.2017.07.009
16- Chowdhury UK, Narag R, Malhotra P, Choudhury M, Choudhury A, Singh, Sarvesh P. Indications, timing and techniques of radical pericardiectomy via modified left anterolateral thoracotomy (UKC’s modification) and total pericardiectomy via median (Holman and Willett) without cardiopulmonary bypass. J Prac Cardiovasc Sci 2016; 2: 17-27. https://doi.org/10.4103/2395-5414.182999
17- Choi MS, Jeong DS, Oh JK, Chang SA, Park SJ, Chung S. Long-term results of radical pericardiectomy for constrictive pericarditis in Korean population. J Cardiothorac Surg 2019; 14(1): 32.
https://doi.org/10.1186/s13019-019-0845-7
18- Góngora E, Dearani JA, Orszulak TA, Schaff HV, Li Z, Sundt TM. Tricuspid regurgitation in patients undergoing pericardiectomy for constrictive pericarditis. Ann Thorac Surg 2008; 85(1): 163-70; discussion 170-1. https://doi.org/10.1016/j.athoracsur.2007.06.051
19- Szabó G, Schmack B, Bulut C, Soós P, Weymann A, Stadtfeld S, et al., Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg 2013; 44(6): 1023-8; discussion 1028. https://doi.org/10.1093/ejcts/ezt138
20- Ni Y, von Segesser LK, Turina M. Futility of pericardiectomy for post irradiation constrictive pericarditis? Ann Thorac Surg 1990; 49(3): 445-8. https://doi.org/10.1016/0003-4975(90)90252-2
21- Karram T, Rinkevitch D, Markiewicz W. Poor outcome in radiation-induced constrictive pericarditis. Int J Radiat Oncol Biol Phys 1993; 25(2): 329-31.https://doi.org/10.1016/0360-3016(93)90356-Z
22- Buyukbayrak F, Aksoy E, Dedemoglu M, Kirali K, Alp HM. Pericardiectomy for treatment of neoplastic constrictive pericarditis. Asian Cardiovasc Thorac Ann 2014; 22(3): 296-300. https://doi.org/10.1177/0218492313484317
23- Gillaspie EA, Dearani JA, Daly RC, Greason KL, Joyce LD, Oh J, et al., Pericardiectomy After Previous Bypass Grafting: Analyzing Risk and Effectiveness in this Rare Clinical Entity. Ann Thorac Surg 2017; 103(5): 1429-33. https://doi.org/10.1016/j.athoracsur.2016.08.087
24- Yunfei L, Tao L, Yongjun Q. Re-pericardiectomy for recurrent chronic constrictive pericarditis: left anterolateral thoracotomy is a better approach. J Cardiothorac Surg 2019; 14(1): 152.
https://doi.org/10.1186/s13019-019-0978-8
25- Welch TD. Constrictive pericarditis: diagnosis, management and clinical outcomes. Heart 2018; 104(9): 725-731. doi: 10.1136/heartjnl-2017-311683.
26- Cinar B, Enc Y, Goksel O, Cimen S, Ketenci B, Teskin O, et al. Chronic constrictive tuberculous pericarditis: risk factors and outcome of pericardiectomy. Int J Tuberc Lung Dis 2006; 10(6): 701-6.
27- Peset AM, Martí V, Cardona M, Montiel J, Guindo J, de Rozas JD. Outcome of Pericardiectomy for Chronic Constrictive Pericarditis. Rev Esp Cardiol 2007; 60(10): 1097-101. https://doi.org/10.1157/13111243
28- George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, Conte JV. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg 2012; 94(2): 445-51.
https://doi.org/10.1016/j.athoracsur.2012.03.079
29- Biçer M, Özdemir B, Kan İ, Yüksel A, Tok M, Şenkaya I. Long-term outcomes of pericardiectomy for constrictive pericarditis. J Cardiothorac Surg 2015; 10: 177. https://doi.org/10.1186/s13019-015-0385-8
30- Nozohoor S, Johansson M, Koul B, Cunha-Goncalves D. Radical pericardiectomy for chronic constrictive pericarditis. J Card Surg 2018; 33(6): 301-7.https://doi.org/10.1111/jocs.13715
31- Gillaspie EA, Stulak JM, Daly RC, Greason KL, Joyce LD, Oh J, et al., A 20-year experience with isolated pericardiectomy: Analysis of indications and outcomes. J Thorac Cardiovasc Surg 2016; 152(2): 448-58.
https://doi.org/10.1016/j.jtcvs.2016.03.098
32- Zhu P, Mai M, Wu R, Lu C, Fan R, Zheng S. Pericardiectomy for constrictive pericarditis: single-center experience in China. J Cardiothorac Surg 2015; 10: 34.https://doi.org/10.1186/s13019-015-0237-6
33- Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al., Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation 1999; 100(13): 1380-6. https://doi.org/10.1161/01.CIR.100.13.1380
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