PMID- 31439013
OWN - NLM
STAT- MEDLINE
DCOM- 20191126
LR  - 20200225
IS  - 1749-8090 (Electronic)
IS  - 1749-8090 (Linking)
VI  - 14
IP  - 1
DP  - 2019 Aug 22
TI  - Re-pericardiectomy for recurrent chronic constrictive pericarditis: left 
      anterolateral thoracotomy is a better approach.
PG  - 152
LID - 10.1186/s13019-019-0978-8 [doi]
LID - 152
AB  - BACKGROUND: Pericardiectomy is the final treatment for constrictive pericarditis. 
      However, this greatest surgical approach is still very controversial. This study 
      pursued to assess the outcomes in patients with recurrent chronic constrictive 
      pericarditis undergoing reoperated pericardiectomy via median sternotomy versus 
      left anterolateral thoracotomy and to explain which surgical approaches might be 
      better for recurrent chronic constrictive pericarditis. METHODS: A total of 24 
      patients were identified with recurrent chronic constrictive pericarditis and 
      underwent reoperation with pericardiectomy between July 2003 and July 2015. The 
      decision for this surgical approach was mainly dependent on the operating 
      surgeon's preference. Out of 20 patients, 16 patients underwent pericardiectomy 
      via median sternotomy and 8 patients via left anterolateral thoracotomy 
      pericardiectomy. Their data were obtained retrospectively from the case notes. 
      RESULTS: Both groups of patients were similar in age, gender between two 
      operations, and also in peripheral venous pressure, cardiac rhythm and New York 
      Heart Association (NYHA) class distribution. The mortality rates were similar in 
      both groups with one death (12.5%) due to low cardiac output syndrome in the left 
      anterolateral thoracotomy group and two deaths (12.5%) in the median sternotomy 
      group. All the deaths were associated with cardiac complications and happened in 
      the perioperative period. NYHA functional class status enhanced in most of the 
      patients. Patients in both groups had a similar and significant improvement in 
      their NYHA status that improved from 3.4 +/- 0.7 to 1.8 +/- 0.1 (P = 0.001) in the 
      left anterolateral thoracotomy group and reduced from 3.3 +/- 0.6 to 1.9 +/- 0.4 
      (P = 0.001) in the median sternotomy group. There was a significantly greater 
      rate of pulmonary infection in the thoracotomy group than in the median 
      sternotomy group (50% versus 25%, P = 0.02). Nevertheless, there was a 
      significantly greater occurrence of wound infections in the median sternotomy 
      group in 3 patients versus in one patient of the left anterolateral thoracotomy 
      group (18.8% versus 12.5%, P = 0.02). CONCLUSIONS: Left thoracotomy incision was 
      preferred to sternotomy in the current setting of this situation and was done 
      safely without CPB. It avoided life-threatening sternal infection and it also has 
      showed an equal as well las significant enhancement of NYHA status of the 
      patients.
FAU - Yunfei, Ling
AU  - Yunfei L
AD  - Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 
      Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China.
FAU - Tao, Li
AU  - Tao L
AD  - Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 
      Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China.
FAU - Yongjun, Qian
AU  - Yongjun Q
AUID- ORCID: 0000-0002-8013-4070
AD  - Department of Cardiovascular Surgery, West China Hospital, Sichuan University, 
      Guoxuexiang 37th, 610041, Chengdu, Sichuan, People's Republic of China. 
      qianyongjun@scu.edu.cn.
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20190822
PL  - England
TA  - J Cardiothorac Surg
JT  - Journal of cardiothoracic surgery
JID - 101265113
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Cardiac Output, Low/etiology
MH  - Female
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Pericardiectomy/adverse effects/*methods/mortality
MH  - Pericarditis, Constrictive/mortality/physiopathology/*surgery
MH  - Perioperative Period
MH  - Pneumonia/etiology
MH  - Recurrence
MH  - *Reoperation
MH  - Retrospective Studies
MH  - Sternotomy/*methods
MH  - Surgical Wound Infection/etiology
MH  - Thoracotomy/*methods
MH  - Young Adult
PMC - PMC6704570
OTO - NOTNLM
OT  - Constrictive pericarditis
OT  - Left anterolateral thoracotomy
OT  - Pericardiectomy
OT  - Reoperation
COIS- The authors declare that they have no competing interests.
EDAT- 2019/08/24 06:00
MHDA- 2019/11/27 06:00
PMCR- 2019/08/22
CRDT- 2019/08/24 06:00
PHST- 2019/03/24 00:00 [received]
PHST- 2019/08/15 00:00 [accepted]
PHST- 2019/08/24 06:00 [entrez]
PHST- 2019/08/24 06:00 [pubmed]
PHST- 2019/11/27 06:00 [medline]
PHST- 2019/08/22 00:00 [pmc-release]
AID - 10.1186/s13019-019-0978-8 [pii]
AID - 978 [pii]
AID - 10.1186/s13019-019-0978-8 [doi]
PST - epublish
SO  - J Cardiothorac Surg. 2019 Aug 22;14(1):152. doi: 10.1186/s13019-019-0978-8.