Surgical treatment of tuberculous chronic constrictive pericarditis: A retrospective observational study from tertiary hospital of eastern Nepal

摘要

Background: Tuberculosis remains an important cause of chronic constrictive pericarditis (CCP) in developing countries. It is a surgically treatable cause of diastolic heart failure. Without surgery, it is associated with high morbidity and mortality. Methods: We conducted a retrospective observational study of clinical presentations and perioperative outcomes of pericardiectomy in all patients operated from July 2015 to December 2018 for tuberculous CCP. Results: A total 14 patients (mean age - 38 ± 13.3 years, 10 male), underwent pericardiectomy via median sternotomy without cardiopulmonary bypass. Eleven patients (79) had completed treatment for pulmonary tuberculosis, and three (21) were on anti-tubercular treatment at the time of referral for surgery. Ten patients (71) had prior hos-pitalisation for cardiac failure. At the time of surgery, eight patients (57) were in New York Heart Association (NYHA) class III-IV. The median duration of symptoms before surgical intervention was 15 months (range 11e24 months). Three patients (21) had associated cardiac cirrhosis. Twelve patients (86) underwent total pericardiectomy. Two patients (14) underwent partial pericardiectomy. The mean operative time was 160 ± 33.8 minutes. The mean central venous press pressure before and after surgery were 28 ± 3.9 and 10 ± 2 mmHg respectively. The mean intensive care unit (ICU) and hospital stays were 4 ± 1.5 and 10 ± 2 days respectively. There was one (7) 30-day mortality. There were two deaths (14) due to non-cardiac causes at 10 and 16 months respectively. The remaining 11 patients (79) are doing well (mean follow-up- 23 months), and are in NYHA class I.