Ruoyu Zhang, Axel Haverich, Shrestha Malakh, Christoph Bara; Division of Thoracic and Cardiovascular Surgery, Medical School Hannover, Hannover, Germany
Objective: In chronic constrictive pericarditis, prolonged cardiac compression is sought to predispose the heart to atrophy due to its inability to function properly (disuse atrophy). Not infrequently, myocardial atrophy may have been developed before established reduction of left ventricular systolic function. We sought to analyze the effect of significant myocardial atrophy in the patients with chronic constrictive pericarditis on the peri-operative outcome following pericardiectomy.Methods: From 1997 to 2006, 31 adult (25 men, mean age 57.4±10.1 yrs) underwent pericardiectomy due to chronic constrictive pericarditis in our institution. Myocardial atrophy was examined with echocardiography and CT/MRI. Significant myocardial atrophy was characterized by 1) thinning of the posterior wall (< 10mm), 2) reduction of the posterior wall thickening during the cardiac cycle (<40%). 17 pts with significant myocardial atrophy were defined as group I (n=14), the others without significant myocardial atrophy were defined as group II (n=17). Medical records were retrospectively reviewed.
Results: The peri-operative mortality rate was 6.5% (2 pts, both in group I), the cause of death in both cases was severe low cardiac output syndrome. Median stay in the intensive care unit was 3.97±6.3 days, median hospital stay 16.1±10.8 days. The demographic characteristics and surgical approach in 2 groups have not significant differences. The patients in group I had a significantly prolonged stay in the intensive care unit (6.1±8.4 days) and hospital stay (21.1±13.9 days) compared to the patients in group II with 1.5±0.7 days ICU stay and 11.5±2.5 days hospital stay (p=0.025, p=0.014, respectively), while the left ventricular systolic function in the two groups did not differ significantly ( LVEF=64.4% in group I and 67.6% in group II, p=0.232). By Cox proportional hazards regression, interventricular septum thickness at end-diastole (IVSTd) and right ventricular end diastolic dimension (RVEDD) were independent determinants of postoperative ICU stay (p=0.017, p=0.029, respectively) and hospital stay (p=0.031, p=0.018, respectively).
Conclusion: In the present study, myocardial atrophy resulted in poor perioperative outcome following pericardiectomy in patients with chronic constrictive pericarditis. We recommend frequent echocardiography examination for patients with chronic constrictive pericarditis regarding myocardial atrophy and timely operative intervention despite sustained left ventricular systolic function.
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