Incomplete Pericardial Dissection, Fluid Overload, Delayed Diagnosis And Treatment, And Tuberculosis Pericarditis Are Associated With Low Cardiac Output Syndrome Following Pericardiectomy
DOI:
https://doi.org/10.1532/hsf.4449Keywords:
Incomplete pericardial dissection, fluid overload, tuberculosis pericarditis, low cardiac output syndrome, pericardiectomyAbstract
Background: We aimed to investigate risk factors of LCOS following pericardiectomy.
Methods: This was a retrospective study of patients undergoing pericardiectomy at three hospitals between January 1994 and May 2021.
Results: A total of 826 patients were divided into two groups: group with LCOS (N = 126) and group without LCOS (N = 700). The incidence of postoperative LCOS was 15.3%. There were 66 operative deaths (8.0%). Univariable and multivariable analyses showed that factors are associated with LCOS, including postoperative LVEDD (P < 0.001), preoperative LVEDD (P < 0.001), time between symptoms and surgery (P < 0.001), thickness of pericardium (P < 0.001), intubation time (P = 0.002), hospitalized time postoperative (P < 0.001), preoperative central venous pressure (P = 0.016), postoperative central venous pressure (P = 0.034), D0 fluid balance (P = 0.019), D2 fluid balance (P = 0.017), postoperative chest drainage (P < 0.001), surgical duration (P < 0.001), bleeding during operation (P = 0.001), serum creatinine 24h after surgery (P < 0.001), serum creatinine 48h after surgery (P = 0.017), fresh-frozen plasma (P = 0.005), packed red cells (P = 0.006), and tuberculosis pericarditis (P = 0.026).
Conclusion: In our study, incomplete pericardial dissection, fluid overload, delayed diagnosis and treatment, and tuberculosis pericarditis are associated with LCOS following pericardiectomy.
References
Ahmad H, Porter R, Yusuff H, et al. 2019. Extracorporeal membrane oxygenation for right ventricular failure following pericardiectomy. Eur J Cardiothorac Surg. 56(3):625-626.
Bagshaw SM, Cruz DN. 2010. Fluid overload as a biomarker of heart failure and acute kidney injury. Contrib Nephrol. 164:54–68.
Bautista-Hernandez V, Karamanlidis G, McCully JD, et al. 2016. Cellular and Molecular Mechanisms of Low Cardiac Output Syndrome after Pediatric Cardiac Surgery. Curr Vasc Pharmacol. 14(1):5-13.
Bernal W, Wendon J. 2013. Acute Liver Failure. N Engl J Med. 369:2525-34.
Bhattad P, Jain V. 2020. Constrictive Pericarditis: A Commonly Missed Cause of Treatable Diastolic Heart Failure. Cureus. 12(5): e8024.
Burak CD, Parmeseeven M, Nicola V, et al. 2017. Surgical Treatment of Constrictive Pericarditis. Tex Heart Inst J. 44(2): 101-6.
Chandler HK, Kirsch R. 2016. Management of the Low Cardiac Output Syndrome Following Surgery for Congenital Heart Disease. Curr Cardiol Rev. 12(2):107-11.
Chang SA, Oh JK. 2019. Constrictive Pericarditis: A Medical or Surgical Disease? J Cardiovasc Imaging. 27(3):178-186.
Du X, Chen H, Song X, et al. 2020. Risk factors for low cardiac output syndrome in children with congenital heart disease undergoing cardiac surgery: a retrospective cohort study. BMC Pediatr. 20(1):87.
Durham RM, Moran JJ, Mazuski JE, et al. 2003. Multiple Organ Failure in Trauma Patients, Journal of Trauma. 55(4):608–616.
Epting CL, McBride ME, Wald EL, et al. 2016. Pathophysiology of Post-Operative Low Cardiac Output Syndrome. Curr Vasc Pharmacol. 14(1):14-23.
Fang L, Yu G, Huang J, et al. 2020. Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis. J Cardiothorac Surg. 15(1):148.
Gatti G, Fiore A, Ternacle J, et al. 2020. Pericardiectomy for constrictive pericarditis: a risk factor analysis for early and late failure. Heart Vessels. 35(1):92-103.
Howitt SH, Grant SW, Caiado C, et al. 2018. The KDIGO acute kidney injury guidelines for cardiac surgery patients in critical care: a validation study. BMC Nephrol. 19(1):149.
Ling LH, Oh JK, Schaff HV, Danielson GK, Mahoney DW, Seward JB, et al. 1999. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy. Circulation. 100(13):13806.
Maisch B, Seferovic PM, Ristic AD, et al. 2004. Guidelines on the diagnosis and management of pericardial diseases executive summary; the task force on the diagnosis and management of pericardial diseases of the Euro-pean Society of Cardiology. Eur Heart J. 25(7):587-610.
McCaughan BC, Schaff HV, Piehler JM, et al. 1985. Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg. 89(3):340-50.
Melo DTP, Nerbass FB, Sayegh ALC, et al. 2019. Impact of pericardiectomy on exercise capacity and sleep of patients with chronic constrictive pericarditis. PLoS One. 14(10):e0223838.
Mori M, Mullan CW, Bin Mahmood SU, et al. 2019. US National Trends in the Management and Outcomes of Constrictive Pericarditis: 2005-2014. Can J Cardiol. 35(10):1394-1399.
Roussos C, Koutsoukou A. 2003. Respiratory failure. Eur Respir J. 22: Suppl. 47, 3s–14s.
Rupprecht L, Putz C, Flörchinger B, et al. 2018. Pericardiectomy for Constrictive Pericarditis: An Institution's 21 Years Experience. Thorac Cardiovasc Surg. 66(8):645-650.
Unai S, Johnston DR. 2019. Radical Pericardiectomy for Pericardial Diseases. Curr Cardiol Rep. 21(2):6.
Vondran M, Rylski B, Berezowski M, et al. 2019. Preemptive Extracorporeal Life Support for Surgical Treatment of Severe Constrictive Pericarditis. Ann Thorac Surg. 108(5):1376-1381.
Walker LJ, Young PJ. 2015. Fluid administration, vasopressor use and patient outcomes in a group of high-risk cardiac surgical patients receiving postoperative goal-directed haemodynamic therapy: a pilot study. Anaesth Intensive Care. 43(5):617-27.
