Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years’ experience in Cote d’Ivoire

Koffi Herve Yangni-Angate, Tanauh Yves, Meneas Christophe, Diby Florent, Adoubi Anicet, Diomande Manga


Background: Surgical experience with chronic constrictive pericarditis (CCP) is rarely documented in Africa; the aim of this study is therefore to review our African experience with CCP from 1977 to 2012 in terms of clinical and surgical outcomes and risk factors of early death after pericardectomy.
Methods: This retrospective study is related to 120 patients with CCP; there were 72 men and 48 women with an average age at 28.8±10.4 years standard deviation (SD) (8–51 years). The main etiology was tuberculosis (99%). Symptoms secondary to systemic venous congestion were always present: patient were functionally classified according New York Heart Association (NYHA) functional classification: 63 patients presented in class II NYHA and 57 in class III or IV NYHA. The diagnosis confirmed by surgical report was: sub-acute CCP (n=12; 10%), fibrous CCP (n=36; 30%), calcified CCP (n=72; 60%). A pericardiectomy including an epicardiectomy with a systematic release of the ventricles was carried out in every case. Median sternotomy was frequently performed (n=117; 97.5%).
Results: Fifteen early deaths (12.5%) were observed, the cause of hospital deaths was due to a low cardiac output (n=12) and to a hepatic failure (n=3). Class III or IV (NYHA) (P=0.01), mitral regurgitation (P<0.05), persistent a diastolic syndrome after surgery (P<0.05) and low cardiac index (CI) (P<0.02) were the important risk factors. Age, size of cardiac X-ray silhouette, right and left ventricular diastolic pressures, ejection fraction (EF), atrial fibrillation and pericardial calcifications had no impact on early survival. The average follow up was 4 years (1–10 years); we lost 22 patients during follow-up. Among survivors, there was no late death; the patients were in class I or II NYHA. Post-operative catheterization evaluation (n=30) shown a significant decrease of the right and left ventricular end-diastolic pressures (P<0.05), of the pulmonary capillary wedge pressure (PCWP) (P<0.05) and of the right atrial pressure (RAP) (P<0.05) and a disappearance of the lack of ventricular diastolic distensibility.
Conclusions: Based on our experience, CCP surgery can be performed safely with an acceptable hospital mortality and a significant improvement of patients’ functional status at long term after surgery.