Impact of left ventricular function on immediate and long-term outcomes after pericardiectomy in constrictive pericarditis

Jong Won Ha, Jae K. Oh, Hartzell V. Schaff, Lieng H. Ling, Stuart T. Higano, Doug W. Mahoney, Rick A. Nishimura

Research output: Contribution to journalArticle

23 Scopus citations

Abstract

Objective: Most patients with constrictive pericarditis have normal measures of left ventricular function when assessed by the ejection phase index of ejection fraction, yet there is a wide spectrum of outcome after pericardiectomy. We hypothesized that parameters of non-ejection indexes of cardiac function (+dP/dt and tau) may predict postoperative prognosis. Methods: The immediate and long-term outcomes of pericardiectomy were analyzed in 40 patients (30 male, mean age 62 years) with surgically confirmed constrictive pericarditis who underwent preoperative cardiac catheterization using high-fidelity micromanometer pressures. Left ventricular pressures were digitized at 5-msec intervals during end expiration, from which peak positive dp/dt and tau measurements were obtained. Patients were classified into 3 groups: Group 1 (n = 13) included those with abnormal +dP/dt and tau (defined as +dP/dt < 1200 mm Hg/s, tau > 50 msec); group 2 (n = 11) included those with either abnormal +dP/dt or tau; and group 3 (n = 16) included those with normal +dP/dt and tau. Results: There were no significant differences of gender, New York Heart Association class, duration of symptoms, and underlying cause among the 3 groups. Group 1 patients had lower preoperative ejection fraction and higher left and right ventricular end-diastolic pressures. Postoperative inotropic support was more frequently needed in group 1, and postoperative mortality was higher in group 1 than in groups 2 and 3. All postoperative deaths but 1 were in group 1. The median postoperative follow-up was 2.4 years. The postoperative long-term survival of group 1 was significantly lower compared with that of groups 2 and 3. Conclusion: In patients with constrictive pericarditis undergoing pericardiectomy, those with abnormal left ventricular contractility and relaxation properties assessed by cardiac catheterization before surgery incur higher operative mortality and poor long-term outcome after surgery.

Original languageEnglish (US)
Pages (from-to)1136-1141
Number of pages6
JournalJournal of Thoracic and Cardiovascular Surgery
Volume136
Issue number5
DOIs
StatePublished - Nov 1 2008

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

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