Pericardiectomy for chronic constrictive tuberculous pericarditis: risks and predictors of survival.
We performed this study to determine the predictors of early and long-term survival in the surgical treatment of tuberculous pericarditis and to examine the risks of pericardiectomy and the functional outcome in patients after surgery. A retrospective analysis was undertaken in 36 consecutive patients, 26 female and 10 male, with a mean age 32.2 +/- 16.3, who underwent pericardiectomy for chronic constrictive pericarditis from February 1985 to February 2002. All patients received antitubercular therapy in the postoperative period. The operative mortality rate was 6% (2 patients); the cause of death in both cases was severe low-cardiac-output syndrome. Nonfatal intraoperative complications affected 3 patients (8%). The median stay in the intensive care unit was 3.7 +/- 3.1 days. The median hospital stay was 14 +/- 2.6 days. The median ventilation time was 11.9 +/- 1.8 hours. The median volume of blood transfused was 2.1 +/- 1.6 units. Advanced age, atrial fibrillation, concomitant tricuspid insufficiency, inotropic support and low cardiac output were significant negative predictors of survival, according to univariate analysis. There were 4 late deaths. Actuarial survival at 5 years was 75.9% +/- 9.14%. At the 1-year follow-up examination, improved functional status was noted in 88% of patients. We suggest that pericardiectomy be performed early and as radically as possible, in an effort to prevent chronic illness. A combination of chemotherapy and surgery yields gratifying results in the treatment of tuberculous pericarditis.
Bozbuga
Nilgun
N
Department of Cardiovascular Surgery, Kosuyolu Heart and Research Hospital, Istanbul, Turkey. nbozbuga@kosuyolu.gov.tr
Erentug
Vedat
V
Eren
Ercan
E
Erdogan
Hasan Basri
HB
Kirali
Kaan
K
Antal
Arzu
A
Akinci
Esat
E
Yakut
Cavat
C
D000293:Adolescent; D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy / Q000009:adverse effects*; D010494:Pericarditis, Constrictive / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D010495:Pericarditis, Tuberculous / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D011237:Predictive Value of Tests; D020127:Recovery of Function / Q000502:physiology; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors