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Arquivos Brasileiros de Cardiologia May 2023
Topics: Humans; Pericardiectomy; Pericardium; Echocardiography
PubMed: 37341300
DOI: 10.36660/abc.20230290 -
BMC Anesthesiology Jun 2023Constrictive pericarditis (CP) is an uncommon disease that limits both cardiac relaxation and contraction. Patients often present with right-sided heart failure as the...
BACKGROUND
Constrictive pericarditis (CP) is an uncommon disease that limits both cardiac relaxation and contraction. Patients often present with right-sided heart failure as the pericardium thickens and impedes cardiac filling. Pericardiectomy is the treatment of choice for improving hemodynamics in CP patients; however, the procedure carries a high morbidity and mortality, and the anesthetic management can be challenging. Acute heart failure, bleeding and arrhythmias are all concerns postoperatively.
METHODS
After IRB approval, we performed the retrospective analysis of 66 consecutive patients with CP who underwent pericardiectomy from July 2018 to May 2022.
RESULTS
Most patients had significant preoperative comorbidities, including congestive hepatopathy (75.76%), New York Heart Association Type III/IV heart failure (59.09%) and atrial fibrillation (51.52%). Despite this, 75.76% of patients were extubated within the first 24 h and all but 2 of the patients survived to discharge (96.97%).
CONCLUSIONS
Anesthetic management, including a thorough understanding of the pathophysiology of CP, the use of advanced monitoring and transesophageal echocardiography (TEE) guidance, all played an important role in patient outcomes.
Topics: Humans; Pericardiectomy; Retrospective Studies; Pericarditis, Constrictive; Heart Failure; Anesthesia
PubMed: 37264299
DOI: 10.1186/s12871-023-02155-4 -
Frontiers in Cardiovascular Medicine 2022Acute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We...
OBJECTIVES
Acute kidney injury is a common complication after pericardiectomy for constrictive pericarditis, which predisposes patients to worse outcomes and high medical costs. We aimed to investigate potential risk factors and consequences and establish a prediction model.
METHODS
We selected patients with constrictive pericarditis receiving isolated pericardiectomy from January 2013 to January 2021. Patients receiving concomittant surgery or repeat percardiectomy, as well as end-stage of renal disease were excluded. Acute kidney injury was diagnosed and classified according to the KDIGO criteria. Clinical features were compared between patients with and without postoperative acute kidney injury. A prediction model was established based on multivariable regression analysis.
RESULTS
Among two hundred and eleven patients, ninety-five (45.0%) developed postoperative acute kidney injury, with fourty-three (45.3%), twenty-eight (29.5%), and twenty-four (25.3%) in mild, moderate and severe stages, respectively. Twenty-nine (13.7%) patients received hemofiltration. Nine (4.3%) patients died perioperatively and were all in the acute kidney injury (9.5%) group. Eleven (5.2%) patients were considered to have chronic renal dysfunction states at the 6-month postoperative follow-up, and eight (72.7%) of them experienced moderate to severe stages of postoperative acute kidney injury. Univariable analysis showed that patients with acute kidney injury were older (difference 8 years, < 0.001); had higher body mass index (difference 1.68 kg·m, = 0.002); rates of smoking ( = 2, = 0.020), hypertension ( = 2.83, = 0.004), and renal dysfunction ( = 3.58, = 0.002); higher central venous pressure (difference 3 cm HO, < 0.001); and lower cardiac index (difference -0.23 L·min·m, < 0.001) than patients without acute kidney injury. Multivariable regression analysis showed that advanced age (OR 1.03, = 0.003), high body mass index (OR 1.10, = 0.024), preoperative atrial arrhythmia (OR 3.12, = 0.041), renal dysfunction (OR 2.70 = 0.043), high central venous pressure (OR 1.12, = 0.002), and low cardiac index (OR 0.36, = 0.009) were associated with a high risk of postoperative acute kidney injury. A nomogram was established based on the regression results. The model showed good model fitness (Hosmer-Lemeshow test = 0.881), with an area under the curve value of 0.78 (95% CI: 0.71, 0.84, < 0.001).
CONCLUSION
The prediction model may help with early recognition, management, and reduction of acute kidney injury after pericardiectomy.
PubMed: 35224038
DOI: 10.3389/fcvm.2022.790044 -
Cardiovascular Drugs and Therapy Aug 2023Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This systematic review aimed to investigate the efficacy of colchicine, indomethacin, and... (Review)
Review
PURPOSE
Post-pericardiotomy syndrome (PPS) is a common complication of cardiac surgery. This systematic review aimed to investigate the efficacy of colchicine, indomethacin, and dexamethasone in the treatment and prophylaxis of PPS.
METHODS
Literature research was carried out using PubMed. Studies investigating ≥ 10 patients with clinically PPS treated with colchicine, dexamethasone, and indomethacin and compared with placebo were included. Animal or in vitro experiments, studies on < 10 patients, case reports, congress reports, and review articles were excluded. Cochrane risk-of-bias tool for randomized trials (RoB2) was used for the quality assessment of studies.
RESULTS
Seven studies were included. Among studies with postoperative colchicine treatment, two of them demonstrated a significant reduction of PPS. In the single pre-surgery colchicine administration study, a decrease of PPS cases was registered. Indomethacin pre-surgery administration was linked to a reduction of PPS. No significant result emerged with preoperative dexamethasone intake.
CONCLUSION
Better outcomes have been registered when colchicine and indomethacin were administered as primary prophylactic agents in preventing PPS and PE. Further RCT studies are needed to confirm these results.
Topics: Humans; Pericardiectomy; Postpericardiotomy Syndrome; Cardiac Surgical Procedures; Colchicine; Indomethacin; Dexamethasone
PubMed: 34546452
DOI: 10.1007/s10557-021-07261-4 -
Frontiers in Veterinary Science 2021Aortic body tumors, specifically chemodectomas, are the second most common type of canine cardiac tumor; however, information about treatment is currently lacking. This...
Aortic body tumors, specifically chemodectomas, are the second most common type of canine cardiac tumor; however, information about treatment is currently lacking. This study included dogs with a presumptive or definitive diagnosis of an aortic body chemodectoma that underwent treatment with toceranib phosphate. Cases were solicited via the American College of Veterinary Internal Medicine Cardiology, Internal Medicine, and Oncology listservs using an electronic survey. Cox multivariate analysis of factors potentially impacting survival time was completed. Twenty-seven (27) cases were included in analysis. The clinical benefit rate (complete remission, partial remission, or stable disease >10 weeks) was 89%. A median survival time of 478 days was found for those receiving toceranib alone ( = 14), which was not statistically different from those treated with additional modalities (521 days). No factors evaluated statistically impacted outcome. Further, prospective studies are warranted to evaluate the use of toceranib for the treatment of canine aortic body chemodectomas.
PubMed: 33614771
DOI: 10.3389/fvets.2021.635057 -
BMJ Case Reports Mar 2021A 59-year-old man presented with exertional dyspnoea and pretibial oedema that had lasted 6 months. He was referred to our hospital with suspected constrictive...
A 59-year-old man presented with exertional dyspnoea and pretibial oedema that had lasted 6 months. He was referred to our hospital with suspected constrictive pericarditis (CP). Several examinations, including CT, echocardiography and cardiac catheterisation, indicated heart failure associated with CP that had been induced by trauma 13 years prior. The CP and heart failure were unresponsive to medical treatment, therefore, a surgical pericardiectomy was performed, which is considered the only definitive treatment. Pathological examination of the resected pericardium revealed a fatty texture and dense fibrous connective tissues, which are associated with old haemorrhage and focal calcification. The patient's symptoms were improved to New York Heart Association Class I, and his peripheral oedema disappeared 6 months after leaving hospital.
Topics: Echocardiography; Heart Failure; Humans; Male; Middle Aged; Pericardiectomy; Pericarditis, Constrictive; Pericardium
PubMed: 33727294
DOI: 10.1136/bcr-2020-240235 -
Annals of Cardiac Anaesthesia 2017This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive...
OBJECTIVES
This study was designed to prospectively investigate the effects of pericardiectomy via median sternotomy on intra- and postoperative hemodynamics by a new semi-invasive device (Flotrac/VigileoTM monitor) using arterial pressure waveform analysis.
PATIENTS AND METHODS
Thirty consecutive patients aged 15 to 55 years (mean+SD, 31.73 + 13.53 years), who had undergone total pericardiectomy via median sternotomy underwent serial hemodynamic evaluation. FlotracTM Sensor - derived stroke volume, stroke volume variation, systemic vascular resistance index (SVRI), cardiac index and right atrial pressure were measured just before and after pericardiectomy, at 12 hours, 24 hours, 48 hours, 72 hours and at discharge postoperatively.
RESULTS
Majority of patients (73.33%) exhibited statistically significant reduction of right atrial pressure and SVRI along with improvement in cardiac index and oxygen delivery in the immediate and late postoperative period. However, the stroke volume and stroke volume variation did not increase proportionately on completion of surgery. Patients with low cardiac output syndrome exhibited persistently high central venous pressure with reduced cardiac index and echocardiographically abnormal diastolic filling characteristics.
CONCLUSIONS
We conclude that there is early normalization of hemodynamics following pericardiectomy via median sternotomy and the adequacy of pericardiectomy can be accurately assessed by the new semi-invasive arterial pressure waveform analysis device. Stroke volume variation is a non-predictor of fluid requirement during and after pericardiectomy.
Topics: Adolescent; Adult; Atrial Pressure; Chronic Disease; Female; Follow-Up Studies; Hemodynamics; Humans; Intraoperative Period; Male; Middle Aged; Monitoring, Physiologic; Pericardiectomy; Pericarditis, Constrictive; Postoperative Period; Prospective Studies; Reproducibility of Results; Stroke Volume; Treatment Outcome; Vascular Resistance; Young Adult
PubMed: 28393776
DOI: 10.4103/aca.ACA_98_16 -
JACC. Heart Failure Jul 2019The elastic pericardium exerts a compressive contact force on the surface of the myocardium that becomes more substantial when heart volume increases, as in patients... (Review)
Review
The elastic pericardium exerts a compressive contact force on the surface of the myocardium that becomes more substantial when heart volume increases, as in patients with various forms of heart failure (HF). Pericardial restraint plays an important role in determining hemodynamics and ventricular function in both health and disease. This review discusses the physiology of pericardial restraint in HF and explores the question of whether it can be targeted indirectly through medical interventions or directly through a number of existing and future therapies.
Topics: Atrial Pressure; Cardiac Resynchronization Therapy; Diuretics; Heart Failure; Hemodynamics; Humans; Pericardiectomy; Pericardium; Stroke Volume; Vasodilator Agents; Ventricular Pressure; Ventricular Remodeling
PubMed: 31248569
DOI: 10.1016/j.jchf.2019.03.021 -
Perioperative Medicine (London, England) Aug 2022Low cardiac output is the main cause of perioperative death after pericardiectomy for constrictive pericarditis. We investigated the associated risk factors and...
BACKGROUND
Low cardiac output is the main cause of perioperative death after pericardiectomy for constrictive pericarditis. We investigated the associated risk factors and consequences.
METHODS
We selected constrictive pericarditis patients undergoing isolated pericardiectomy from January 2013 to January 2021. Postoperative low cardiac output was defined as requiring mechanical circulatory support or more than one inotrope to maintain a cardiac index > 2.2 L •min •m without hypoperfusion, despite adequate filling status. Uni- and multivariable analysis were used to identify factors associated with low cardiac output. Cox regression was used to identify factors associated with length of hospital stay.
RESULTS
Among 212 patients with complete data, 55 (25.9%) developed low cardiac output within postoperative day 1 (quartiles 1 and 2), which caused seven of the nine perioperative deaths. The rates of atrial arrhythmia, renal dysfunction, hypoalbuminemia, modest-to-severe hyponatremia, and hyperbilirubinemia caused by constrictive pericarditis were 9.4%, 12.3%, 49.1%, 10.4%, and 81.6%. The mean preoperative central venous pressure and cardiac index were 18 ± 5 cmHO and 1.87 ± 0.45 L•min•m. Univariable analysis showed that low cardiac output patients had higher rates of atrial arrhythmia (OR 3.32 [1.35, 8.17], P = 0.007), renal dysfunction (OR 4.24 [1.94, 9.25], P < 0.001), hypoalbuminemia (OR 1.99 [1.06, 3.73], P = 0.031) and hyponatremia (OR 6.36 [2.50, 16.20], P < 0.001), greater E peak velocity variation (difference 2.8 [0.7, 5.0], P = 0.011), higher central venous pressure (difference 3 [2,5] cmHO, P < 0.001) and lower cardiac index (difference - 0.27 [- 0.41, - 0.14] L•min•m, P < 0.001) than patients without low cardiac output. Multivariable regression showed that atrial arrhythmia (OR 4.04 [1.36, 12.02], P = 0.012), renal dysfunction (OR 2.64 [1.07, 6.50], P = 0.035), hyponatremia (OR 3.49 [1.19, 10.24], P = 0.023), high central venous pressure (OR 1.17 [1.08, 1.27], P < 0.001), and low cardiac index (OR 0.36 [0.14, 0.92], P = 0.032) were associated with low cardiac output (AUC 0.79 [0.72-0.86], P < 0.001). Cox regression analysis showed that hyperbilirubinemia (HR 0.66 [0.46, 0.94], P = 0.022), renal dysfunction (HR 0.51 [0.33, 0.77], P = 0.002), and low cardiac output (HR 0.42 [0.29, 0.59], P < 0.001) were associated with length of hospital stay.
CONCLUSIONS
Early recognition and management of hyponatremia, renal dysfunction, fluid retention, and hyperbilirubinemia may benefit constrictive pericarditis patients after pericardiectomy.
PubMed: 35974413
DOI: 10.1186/s13741-022-00267-y -
International Journal of Surgery Case... 2018Pericardiectomy for patients with constrictive pericarditis and multivessel coronary artery disease is rare. Therefore, there is limited experience of pericardiectomy in...
INTRODUCTION
Pericardiectomy for patients with constrictive pericarditis and multivessel coronary artery disease is rare. Therefore, there is limited experience of pericardiectomy in these patients.
PRESENTATION OF CASE
We performed only pericardiectomy under the support of intra-aortic balloon pumping (IABP) for a patient with tuberculous constrictive pericarditis and multivessel coronary artery disease who refused to accept revascularization. The postoperative course was uneventful.
DISCUSSION
There is limited experience of pericardiectomy in patients with constrictive pericarditis and coronary artery disease, especially in those who want to perform only pericardiectomy and refuse to accept revascularization. There has only been one case report of a patient who had constrictive pericarditis and coronary artery disease, and hemodynamic instability postoperatively who did not have revascularization performed. Cardiopulmonary bypass facilitates dissecting grossly thickened pericardium off the heart and coronary artery exposure, but is associated with higher mortality and reoperation rates, renal failure, and atrial fibrillation. In our patient, cutting grossly thickened pericardium to expose the coronary artery under cardiopulmonary bypass was unnecessary because he refused to accept revascularization. Therefore, we performed only pericardiectomy under the support of IABP to avoid hemodynamic instability.
CONCLUSION
Performing only pericardiectomy under the support of IABP for a patient with constrictive pericarditis and multivessel coronary artery disease is safe and effective as long as the left ventricular ejection fraction is normal.
PubMed: 30048912
DOI: 10.1016/j.ijscr.2018.06.034