Surgical Experience with Chronic Invasive Constrictive Pericarditis in an African Setting: A 16 Year Retrospective Review

The aim of this study was to assess early outcomes,morbidity and NYHA functional class status following treatment of chronic invasive constrictive pericarditis by pericardiectomy. A retrospective analysis was carried out in 88 consecutive patients who underwent surgery between 2000 and 2015. There where 55 males (62,5%) and 33 females(37,5%).Age varied from 7 years to 40 years .Early mortality was 13.6%(12/88 patients). The cause of death was low cardiac output syndrome in 4 (4,5%)patients, severe sepsis in 7(7.9%) and haemorrhage in the remaining patient.One patient required ECMO insertion due to associated severe lung adhesions requiring a decortication and resultant air leaks.Three patients required dialysis. In the majority of patients 71,6%(n=63) where in NYHA FC III-IV.The most common cause was tuberculosis in 65.95%(n=58) patients and associated HIV in 13.6%(n=12) patients.One patient required a mitral valve repair and one a coronary bypass graft.The remainder where idiopathic. Pericardiectomy including an epicardiectomy with a systematic release of the ventricles was carried out in every case via sternotomy. The majority of patients pericardiectomy was performed off cardiopulmonary bypass 71.6%(n=63) and the more invasive subgroup required a combination of cardiopulmonary bypass and aortic cross clamp 5.8%(n=5).

In conclusion, pericardiectomy improved symptomatology in the majority of patients. A subgroup of patients did not experience an amelioration in clinical symptoms, probably because myocardial function did not completely recover. Aggressive invasion of the myocardium was associated with a worse preoperative and postoperative outcome and performing the pericardiectomy on aortic cross clamp increased risk of mortality.