Management of Constrictive Pericarditis: a Comparative Study Between Median Sternotomy and Left Thoracotomy

Abstract

Objective: Constrictive pericarditis (CP) requires pericardiectomy but the choice of surgical approach remains controversial. Hence we have reviewed our experience of pericardiectomy carried out for CP and compared the results of pericardiectomy performed by median sternotomy versus left thoracotomy with regard to functional outcomes. Methodology: The study group consisted of 33 patients with CP who underwent pericardiectomy from May 1999 to January 2010 at our institution. There were 22 female and 11 male patients, ranging in age from 5 to 57 years with a mean age of 45 years. Pericardiectomy was performed via median sternotomy in 17 patients (Group A). In the remaining 16 patients (Group B), pericardiectomy was performed via a left anterolateral thoracotomy in the fifth intercostal space. Results: During the subsequent follow-up, both groups of patients showed a similar and significant improvement in New York Heart Association (NYHA) functional class. In the group A, the mean NYHA functional class decreased from 3.3 +/- 0.7 to 1.8 +/- 0.5 (P = 0.0004). In group B, the mean functional class decreased from 3.2 +/- 0.9 to 1.6 +/- 0.6 (P = 0.00005). Also, both groups had a similar and significant improvement in their mean CVP. In the group A, the mean central venous pressure (CVP) decreased from 15.2 +/- 3.1 mmHg to 8.3 +/- 3.2 mmHg (P<0.005). In the group B, the mean CVP decreased from 15.1 +/- 4.9 mmHg to 7.7 +/- 2.4 mmHg (P<0.004). Conclusion: Constrictive physiopathology is a problem primarily of the ventricles and can be alleviated by decorticating both the right and left ventricles. Therefore, CP could be relieved through the left thoracotomy or median sternotomy in most cases. However, echocardiographic findings should be considered to prefer thoracotomy or sternotomy approach.