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

Authors
 Jong-Won Ha  ;  Jae K. Oh  ;  Hartzell V. Schaff  ;  Lieng H. Ling  ;  Stuart T. Higano  ;  Doug W. Mahoney  ;  Rick A. Nishimura 
Citation
 JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY, Vol.136(5) : 1136-1141, 2008 
Journal Title
JOURNAL OF THORACIC AND CARDIOVASCULAR SURGERY
ISSN
 0022-5223 
Issue Date
2008
MeSH
Aged ; Cardiac Catheterization ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Pericarditis, Constrictive/physiopathology* ; Pericarditis, Constrictive/surgery* ; Pericardium/surgery* ; Prognosis ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left/physiology*
Keywords
Aged ; Cardiac Catheterization ; Echocardiography ; Female ; Humans ; Male ; Middle Aged ; Pericarditis, Constrictive/physiopathology* ; Pericarditis, Constrictive/surgery* ; Pericardium/surgery* ; Prognosis ; Stroke Volume ; Treatment Outcome ; Ventricular Function, Left/physiology*
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
Full Text
http://www.sciencedirect.com/science/article/pii/S0022522308011057
DOI
10.1016/j.jtcvs.2008.03.065
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Ha, Jong Won(하종원) ORCID logo https://orcid.org/0000-0002-8260-2958
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/107813
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