Acquired cardiovascular disease
Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: Causes and perioperative outcomes in the HIV era (1990-2012)

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Objective

The causes of constrictive pericarditis and predictors of perioperative outcome after pericardiectomy have not been clearly elucidated, especially in Africa, where the disease characteristics differ from those in developed countries. Furthermore, the effect of human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) on pericardial constriction and outcomes after surgery is unknown. We investigated the causes of constrictive pericarditis, outcomes after pericardiectomy, and predictors of mortality in Cape Town, South Africa, during a 22-year period of high HIV/AIDS prevalence.

Methods

A retrospective review of the medical records of all patients who had undergone pericardiectomy for constrictive pericarditis at Groote Schuur Hospital from January 1, 1990 to December 31, 2012 was performed.

Results

Of 121 patients, 36 (29.8%) had proven tuberculosis, 74 (61.2%) had presumed tuberculosis, 6 (5%) had idiopathic causes, and 5 (4%) had miscellaneous causes of constrictive pericarditis. Seventeen patients (14%) died perioperatively with low cardiac output syndrome the main cause of mortality. On multivariable analysis, serum sodium (hazard ratio, 0.88; 95% confidence interval, 0.80-0.97; P = .009) and preoperative New York Heart Association class IV (hazard ratio, 3.42; 95% confidence interval, 1.29-9.08; P = .014; vs combined class I-III) were independent predictors of early mortality. Of the 121 patients, 14 (11.6%) were HIV positive, with a mean CD4 cell count of 284 ± 133 cells/μL. No early deaths occurred in the HIV-positive patients.

Conclusions

Tuberculosis is the main cause of constrictive pericarditis in South Africa. Despite its efficacy at relieving the symptoms of heart failure, pericardiectomy is associated with high perioperative mortality that was not influenced by HIV status. New York Heart Association functional class IV and hyponatremia predict for early mortality after pericardiectomy.

CTSNet classification

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Abbreviations and Acronyms

AIDS
acquired immunodeficiency syndrome
CP
constrictive pericarditis
HIV
human immunodeficiency virus
HR
hazard ratio
NYHA
New York Heart Association
TB
tuberculosis

Cited by (0)

This study was supported by the Lily and Ernst Hausmann Trust, South African Medical Research Council, and National Research Foundation (IFR2010041700001).

Disclosures: Authors have nothing to disclose with regard to commercial support.