Pericardiectomy for constrictive pericarditis at a single Japanese center: 20?years of experience
Pericardiectomy for constrictive pericarditis at a single Japanese center: 20?years of experience
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日本单一中心进行缩窄性心包炎心包切除术：20 年经验
DOI：
10.1007/s11748-021-01718-x
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发表时间：
2022
影响因子：
1.2
通讯作者：
Fujita Tomoyuki
中科院分区：
文献类型：
--
作者：
Saito Tetsuya;Fukushima Satsuki;Yamasaki Takuma;Kawamoto Naonori;Tadokoro Naoki;Kakuta Takashi;Ikuta Ayumi;Minami Kimito;Ohta Yasutoshi;Fujita Tomoyuki
缩窄性心包炎（CP）是一种罕见的疾病，其诊断和外科治疗仍具有挑战性。本研究的目的是评估我们的日本单中心经验与孤立的心包切除术CP阐明与改善outcomes.MethodsOver一个20年的时间内，44例连续进行孤立的心包切除术在我们的机构的相关因素。CP的病因依次为：特发性（59%）、术后（32%）、结核（7%）和放疗后（2%）。所有患者均采用多种方式诊断为CP，包括超声心动图、心导管插入术、计算机断层扫描或磁共振成像（MRI）。42例（95%）患者行正中胸骨切开术。28例（68%）患者行根治性心包切除术。在多种模态中，心脏MRI具有最高的诊断灵敏度（97.2%）。无手术或住院死亡;该系列中有7例（15.9%）患者发生晚期死亡。多因素分析显示，术前低LVEF是长期死亡的危险因素。7例患者术后因心力衰竭再次入院。多变量分析显示，不完全心包切除术和使用术前正性肌力药是再入院的危险因素heartful.ConclusionsThe诊断使用多模态成像CP是有效的，在我们的机构和标记电影MRI诊断CP的最大敏感性。术前情况，包括术前低LVEF或使用正性肌力药物，与心包切除术后的长期结局相关。心包切除术应尽早进行，尽可能彻底，以防止复发性心力衰竭。
ObjectiveConstrictive pericarditis (CP) is a rare disease, and the diagnosis and surgical treatment of CP remain challenging. The aim of this study was to evaluate our Japanese single-center experience with isolated pericardiectomy for CP to elucidate the factors associated with improved outcomes.MethodsOver a 20-year period, 44 consecutive patients underwent isolated pericardiectomy at our institution. The cause of CP was: idiopathic (59%), postsurgical (32%), tuberculosis (7%), and postradiation (2%) of the patients. All patients were diagnosed with CP using multiple modalities, including echocardiography, cardiac catheterization, computed tomography, or magnetic resonance imaging (MRI). Median sternotomy was performed in 42 (95%) patients. Twenty-eight (68%) patients underwent radical pericardiectomy.ResultsThe postoperative diagnosis in all patients was CP. Among the multiple modalities, cardiac MRI had the greatest diagnostic sensitivity (97.2%). There were no operative or hospital deaths; late mortality occurred in seven (15.9%) patients in the series. Multivariable analysis showed that preoperative low LVEF was a risk factor for long-term mortality. Seven patients were readmitted for heart failure postoperatively. Multivariable analysis showed incomplete pericardiectomy and use of a preoperative inotrope were risk factors for readmission for heart failure.ConclusionsThe diagnosis using multimodality imaging for CP was effective in our institution and tagged cine MRI had the greatest sensitivity in diagnosing CP. Preoperative condition, including preoperative low LVEF or inotrope use, was correlated with long-term outcome after pericardiectomy. Pericardiectomy should be performed early and as radically as possible to prevent recurrent heart failure.