Abstract 18510: Pericardiectomy Impact on Cardiac Index in Patients With Constrictive Pericarditis
Background: Advanced constrictive pericarditis (CP) has been associated with change in cardiac hemodynamics including cardiac output and cardiac index (CI). Etiology and duration of constriction can affect recovery of CI postpericardiectomy. We sought to look into the change in post-operative cardiac index (CI) among different CP etiologies using echocardiogram and right heart catheterization.
Methods: We Included 301 patients from Cleveland Clinic pericardial disease database with surgically confirmed CP form 1999 to 2010. Post-operative CI was measured using Fick method immediately before and after pericardiectomy. The bootstrap-validated analysis of covariates was performed to compare the mean of post-operative CI among different CP etiologies after adjustment with baseline relevant covariates.
Results: Etiology of CP was idiopathic in 136 patients (45%), viral in 24 patients (8%), prior cardiac surgery in 89 patients (30%), autoimmune in 30 patients (10%) and radiation treatment in 22 patients (7%). Mean CI was reduced and improved after pericardiectomy (2.1±0.7 L/min/m2 to 3.0±0.8 L/min/m2, p<0.001). After adjustment for age, gender, NYHA, LVEF, RVSP, medial e’, lateral e’ and pre-operative CI, the post-operative CI recovered based on different etiologies (2.99±0.7, 3.07±0.16, 3.00±0.09, 3.48±0.15 and 2.76±0.17 L/min/m2 for Idiopathic, viral, prior cardiac surgery, autoimmune and post radiation respectively, p=0.019) (Figure1).
Conclusion: Post-operative cardiac index recovery is related to underlying etiology. Considering CP etiology for patient selection for pericardiectomy may identify patients who will benefit from the surgery and avoid post-pericardiectomy low cardiac output syndrome that may lead to early post-operative mortality
- © 2013 by American Heart Association, Inc.