Background: The knowledge on pericardial disease has increased but the
European Society of Cardiology in the last guidelines 2015 stated a section of
perspective and unmet needs referring to the surgical management as one of
these needs. Here, we present an institutional experience to contribute with
other studies in explanation of questionable aspects about their surgical management.
Methods: Among 127 cases (93 adults and 34 children) that were
diagnosed as pericardial syndrome, we retrospectively analyzed 45 cases (40
adults and 5 children) operated for pericardial syndrome from May 2012 to
June 2019. Echocardiogram was the main preoperative diagnostic tool. Surgical
approach was selected according to each diagnosis. Postoperative clinical
assessment, recurrence and mortality rate were the main determinants of
outcome. Results: Regarding pericardial effusions, the mean preoperative medical
treatment period was 17.7 ± 21.9 days and pericardial window through
thoracotomy was the common approach (54.5%). In constrictive pericarditis,
infection was the main etiology (40%), mean preoperative medical treatment
period was 16 ± 8.8 days and complete pericardiectomy was the surgical procedure
for most cases. Trans-sternal drainage was the standard approach for
cardiac tamponade. No postoperative same admission recurrences were reported
and 11 (24.4%) mortalities were recorded, 7 (15.5%) cases of them
were diagnosed as malignant effusions. Conclusion: Decision making and surgical
approach affect the outcome of surgery for pericardial syndromes. Children
are more responsive to medical treatment than adults are. Primary etiology and patient’s condition are still the leading determinants of morbidity and mortality. |
