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Operate Now Pericardium Surgery


Seventy-nine consecutive patients (50 males, 29 females; mean age 40.0±16.7 years; range 14 to 75 years) who underwent an isolated pericardiectomy for CP between January 1997 and September 2010 at a single center were included in this study. The Institutional Education Planning and Ethics Committee approved the study, and the patients’ informed consent was obtained before it began.

Our examination of the patients included the identification of their symptoms and an assessment of their physical characteristics as well as an evaluation of their laboratory, radiological, echocardiographic, angiographic, and operative findings. Transthoracic echocardiography Süt Kardeşler Filmindeki Esrarengiz Canavar was routinely employed, and cardiac catheterization was carried out when the diagnosis was inconclusive. In addition, computed tomography (CT) and coronary angiography were performed in select cases.

A diagnosis of tuberculous PC took place in those who had a positive history for this disease, an adenosine deaminase level of more than 15 U/L in the pericardial fluid or a pathology that pointed to this type of PC. The patients who had received radiotherapy for a malignant disease or who had malignant pericardial involvement were classified as having malignant radiotherapy-induced constrictive PC. Furthermore, those who had undergone previous cardiac surgery or who had a history of trauma were categorized as postsurgical traumatic CP cases. The remaining causes of CP were classified as idiopathic CP, which included the patients who had previously had viral PC.

Pericardial calcification was identified via the preoperative chest X-ray or CT, and congestive liver dysfunction was considered when the blood levels of the aspartate transaminase (AST) and alanine transaminase (ALT) were more than twice the upper limit and the total bilirubin level was above 2 mg/dL. In addition, renal dysfunction was defined as having creatinine levels of more than 2 mg/dL and/or when the patient was on a routine hemodialysis program.

The surgery consisted of a wide excision of the pericardium from one phrenic nerve to the other, including the diaphragmatic part. Cardiopulmonary bypass (CPB) was not routinely employed, but it was instituted when hemodynamic deterioration, epicardial bleeding, or a laceration occurred that was difficult to control. Early mortality was defined as mortality observed within 30 days after the operation.

The independent variables in our study were the following: gender, age, etiology, dyspnea, palpitations, chest pain, the symptomatic period, hepatomegaly, ascites, Operate Now Pericardium Surgery, pretibial edema, the functional status according to the NYHA, pre- and postoperative AF, hyponatremia, hypoalbuminemia, pleural effusion, pericardial thickness, the presence of Operate Now Pericardium Surgery calcification, chronic obstructive pulmonary disease (COPD), coronary Operate Now Pericardium Surgery disease (CAD), hepatic or renal dysfunction, left ventricular ejection fraction (LVEF), systolic pulmonary artery pressure (sPAP), the left atrial dimensions, atrioventricular valve regurgitation, previous pericardiocentesis, Operate Now Pericardium Surgery, the use of an inotropic agent, the emergent institution of CPB, re-exploration for bleeding, and infection. The dependent variables were early and late mortality and survival length (Tables 1 and 2).

Table 1: Risk factors for early mortality according to univariate analyses and the relative risks for categorical variables

Table 2: Scale parameters of the survivors and non-survivors

After evaluating the first third of the patients retrospectively, we then decided to conduct the study prospectively using a risk scoring system consisting of the clinical and laboratory findings of RHF (i.e., dyspnea, edema, hepatomegaly, ascites, pleural effusion, hypoalbuminemia, and congestive liver dysfunction) along with the patient’s NYHA functional class. Each finding represented 1 point and the mathematical value of the NYHA functional class was then added (2, 3, or 4 points for NYHA 2, 3 or 4 classes, respectively). Therefore, each patient had a score that ranged from 1 point to a maximum of 11. No mortality was observed in the patients who had a total score of ≤6 points. The early mortality rates for those with a score of either 7 or 8 points were similar (16.7% and 12.5%, respectively), but the patients with a score of 9 or 10 had very high mortality rates (50% and 100%, respectively) (p=0.000). Thus, the patients were grouped into low, moderate, and high risk categories according to their risk scores in order to achieve a significant difference with regard to the early mortality rates. Category 1 contained patients with scores ranging from 1-6 points, category 2 was composed of There Is No Game with scores ranging from 7-8 points, and category 3 was made up of those with scores ranging from 9-11 points (Table 3). Furthermore, all of the patients underwent surgical therapy even if they had high preoperative risk scores.

Table 3: Early mortality rates according to the number of variables of right heart failure and right heart failure + New York Heart Association

Statistical analysis
The data were coded and recorded using the IBMSPSS for Windows version 17.0.0 software program (SPSS Inc., Chicago, IL, USA), Operate Now Pericardium Surgery. For the univariate analyses, chi-square, Mann-Whitney U, analysis of variance (ANOVA), Kruskal-Wallis, and Kaplan-Meier log-rank tests were Operate Now Pericardium Surgery in the subgroups while for the multivariate analyses, a backward stepwise logistic regression method was used to identify the aforementioned significant risk factors as they related to mortality. Correlations between disease duration (symptomatic period), length of hospital and intensive care unit (ICU) stays, and the preoperative total score were evaluated via the Spearman’s correlation analysis. In all tests, p values of < 0.05 were a ccepted a s b eing statistically significant.







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