Analysis Of Perioperative Risk Factors And Outcome Of Pericardiectomy

Objective This study aims to analyze the potential perioperative risk factors affecting the short-term and long-term outcome of pericardiectomy. Method 95 patients who underwent pericardiectomy at Fuwai Hospital between March 2009 and July 2014 were retrospectively reviewed and their pre-, intra-and post-operaive data were collected. Follow-up was done by telephone to record patients’long-term outcome. The Student t test, X2 test,Kaplan-Meier analysis and other statistical methods were used to examine the potential relationship between risk factors and outcome.Result 95 patients were enrolled and 83 of them were followed up with the mean age of 42.26±14.49 years, including 68 males (71.5%).21 patients (22.1%) suffered from complications and 3 (3.2%) died within the 30 days after the surgery.1 patient (1.1%) died during follow-up. Statistical analysis showed the risk factors affecting postoperative short-term complications included the etiology of pericarditis (P=0.035), concurrent other cardiac surgeries (P=0.022)、preoperative NYHA grade (P=0.026)、 cardiopulmonary bypass (P=0.001)、end-of-operation hyperglycemia(P=0.016). The cutoff value for end-of-operation blood glucose predicting postoperative complications was 7.36mmol/L (sensitⅣity of 50% and specificity of 78.7%). Kaplan-Meier analysis demonstrated that long-term outcome was affected by etiology of pericarditis (P=0.024), preoperative NYHA grade (P=0.013), ASA grade (P=0.005), postoperative complications (P=0.013), postoperative low-cardiac output syndrome (P=0.014) and end-of-operation blood glucose value>7.36mmol/L (P=0.012).Multivariate Cox analysis revealed that preoperative NYHA grade is an independent risk factor predicting postoperative long-term outcome (HR 3.985,95%CI 1.852-8.573, P=0.000).Conclusion The etiology of pericarditis, preoperative NYHA grade and end-of-operation hyperglycemia (>7.36mmol/L) have a significant impact on the short-term and long-term outcome after pericardiectomy. In addition, the occurrence of postoperative short-term complications is affected by concurrent other cardiac surgeries,cardiopulmonary bypass. ASA grade, postoperative complications and postoperative low-cardiac output syndrome are related with long-term outcome. This study provides clinical evidence to the perioperative management of pericardiectomy.