title: Right-Sided Heart Failure and Extracorporeal Life Support in Patients Undergoing Pericardiectomy for Constrictive Pericarditis: A Risk Factor Analysis for Adverse Outcome.
abstract: BackgroundRight ventricular failure is a life-threatening postoperative complication after pericardiectomy. We conducted a retrospective study with a special emphasis on right ventricular failure.MethodsBetween June 1997 and September 2011, 69 patients underwent surgical pericardiectomy at our center. Mean age was 59 ( ±  15.5) years, and 49 (71%) patients were male. Causes of constrictive pericarditis included idiopathic (52%,n= 36), tuberculosis (9%,n= 6), postcardiotomy (12%,n= 8), radiation (4%,n= 3), renal insufficiency (12%,n= 8), and autoimmune disease (12%,n= 8). Concomitant cardiac surgery was performed in 33 (48%) patients.ResultsIn-hospital mortality rate was 14% (10/69 patients). Extracorporeal membrane oxygenation (ECMO) was necessary in 8 (12%) cases because of right (n= 7) or biventricular (n= 1) failure. Statistical analysis showed a significant correlation between early mortality and the following preoperative variables: postcardiotomy (p= 0.049), radiation (p= 0.009), pleural effusion (p= 0.012), ascites (p= 0.039), hepatic congestion (p= 0.023), absence of calcification on X-ray (p= 0.041), tricuspid valve insufficiency (TI,p< 0.001), and low cardiac index (p= 0.003). Diuretic usage (p= 0.044), peripheral edema (p= 0.050), low voltage (p= 0.027), dip-plateau sign (p= 0.027), elevated GGT (p< 0.001), and decreased serum protein (p< 0.001) correlated with ECMO implantation. Binary logistic regression identified pleural effusion (OR = 16.2, 95% CI = 1.4-191.5), moderate/severe TI (OR = 28.8, 95% CI = 2.7-306.8) and low cardiac index (OR = 25.3, 95% CI = 2.0-315.6) as preoperative independent risk factors for early mortality, whereas elevated GGT (OR = 28.3, 95% CI = 2.4-329.2) and decreased protein (OR = 24.7, 95% CI = 1.8-343.7) could predict right ventricular failure with the need for ECMO.ConclusionWe recommend nondelayed ECMO support in case of significant postoperative right-sided heart failure. High-risk patients might benefit from elective pre- or intraoperative ECMO implantation.
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.|Both authors contributed equally to this work.
authors.forename: Erik
authors.initials: E
authors.lastname: Beckmann
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.|Both authors contributed equally to this work.
authors.forename: Issam
authors.initials: I
authors.lastname: Ismail
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Serghei
authors.initials: S
authors.lastname: Cebotari
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Busse
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Andreas
authors.initials: A
authors.lastname: Martens
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Malakh
authors.initials: M
authors.lastname: Shrestha
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Kühn
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Axel
authors.initials: A
authors.lastname: Haverich
authors.affiliation: Department of Cardiac Surgery, Hannover Medical School, Hannover, Germany.
authors.forename: Christine
authors.initials: C
authors.lastname: Fegbeutel
mesh_terms: D000328:Adult; D016208:Databases, Factual; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006333:Heart Failure / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D017052:Hospital Mortality; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D010492:Pericardiectomy / Q000009:adverse effects* / Q000401:mortality; D010494:Pericarditis, Constrictive / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D016278:Ventricular Function, Right; D055815:Young Adult