Right-Sided Heart Failure and Extracorporeal Life Support in Patients Undergoing Pericardiectomy for Constrictive Pericarditis: A Risk Factor Analysis for Adverse Outcome

Abstract

<b>Background</b> Right ventricular failure is a life-threatening postoperative complication after pericardiectomy. We conducted a retrospective study with a special emphasis on right ventricular failure. <b>Methods</b> Between June 1997 and September 2011, 69 patients underwent surgical pericardiectomy at our center. Mean age was 59 ( ± 15.5) years, and 49 (71%) patients were male. Causes of constrictive pericarditis included idiopathic (52%, <i>n</i> = 36), tuberculosis (9%, <i>n</i> = 6), postcardiotomy (12%, <i>n</i> = 8), radiation (4%, <i>n</i> = 3), renal insufficiency (12%, <i>n</i> = 8), and autoimmune disease (12%, <i>n</i> = 8). Concomitant cardiac surgery was performed in 33 (48%) patients. <b>Results</b> In-hospital mortality rate was 14% (10/69 patients). Extracorporeal membrane oxygenation (ECMO) was necessary in 8 (12%) cases because of right (<i>n</i> = 7) or biventricular (<i>n</i> = 1) failure. Statistical analysis showed a significant correlation between early mortality and the following preoperative variables: postcardiotomy (<i>p</i> = 0.049), radiation (<i>p</i> = 0.009), pleural effusion (<i>p</i> = 0.012), ascites (<i>p</i> = 0.039), hepatic congestion (<i>p</i> = 0.023), absence of calcification on X-ray (<i>p</i> = 0.041), tricuspid valve insufficiency (TI, <i>p</i> < 0.001), and low cardiac index (<i>p</i> = 0.003). Diuretic usage (<i>p</i> = 0.044), peripheral edema (<i>p</i> = 0.050), low voltage (<i>p</i> = 0.027), dip-plateau sign (<i>p</i> = 0.027), elevated GGT (<i>p</i> < 0.001), and decreased serum protein (<i>p</i> < 0.001) correlated with ECMO implantation. Binary logistic regression identified pleural effusion (OR = 16.2, 95% CI = 1.4-191.5), moderate/severe TI (OR = 28.8, 95% CI = 2.7-306.8) and low cardiac index (OR = 25.3, 95% CI = 2.0-315.6) as preoperative independent risk factors for early mortality, whereas elevated GGT (OR = 28.3, 95% CI = 2.4-329.2) and decreased protein (OR = 24.7, 95% CI = 1.8-343.7) could predict right ventricular failure with the need for ECMO. <b>Conclusion</b> We recommend nondelayed ECMO support in case of significant postoperative right-sided heart failure. High-risk patients might benefit from elective pre- or intraoperative ECMO implantation.