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Impact of Concomitant Coronary Artery Bypass Grafting on Postoperative Outcomes in Patients Undergoing Pericardiectomy: A 33 Year Experience

Open AccessPublished:November 14, 2022DOI:https://doi.org/10.1016/j.xjon.2022.10.011
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      ABSTRACT

      Objectives

      Combining coronary artery bypass grafting to pericardiectomy can be a technically challenging operation. We sought to study the outcomes of patients undergoing concomitant coronary artery bypass grafting with pericardiectomy.

      Methods

      From July 1983 to August 2016, 70 patients (median age 67 years, 88% men) received concomitant pericardiectomy and coronary artery bypass grafting (PC+CABG). Multivariable analysis was used to identify predictors of mortality. Matched isolated pericardiectomy (PC) patients were identified to compare the postoperative outcomes and the long-term survival in the two cohorts.

      Results

      Compared to the PC group, the cardiopulmonary bypass time was significantly longer in the PC+CABG group (61 versus 82 minutes; P<0.001). In-hospital mortality was 4% in the PC group and 7% in the PC+CABG group (P=0.380). Multivariable analysis identified peripheral vascular disease (HR=2.67; 95% CI: 1.06-6.76; P=0.04) as a predictor of increased morbidity or mortality and a borderline association of NYHA functional class III and IV (HR=2.41; 95% CI: 0.99-5.86; P=0.05) with increased morbidity and mortality among the PC+CABG cohort. Kaplan-Meier estimate demonstrated similar late mortality rates in the two groups at 15-year follow-up (P=0.700).

      Conclusions

      Pericardiectomy and concomitant coronary artery bypass grafting is not associated with increased morbidity or mortality in comparison to isolated pericardiectomy. Coronary artery bypass grafting should not be denied at the time of pericardiectomy.

      Keywords

      Abbreviations:

      CABG (coronary artery bypass grafting), CI (confidence interval), HR (hazard ratio), IQR (interquartile range), NYHA (New York Heart Association), PC (Pericardiectomy), PCI (percutaneous coronary intervention), PVD (peripheral vascular disease)