J. Hadaya1, S. Kim1, S. Mallick1, N. Cho1, Y. Sanaiha1, P. Benharash1 1David Geffen School Of Medicine, University Of California At Los Angeles, Department Of Surgery, Los Angeles, CA, USA
Introduction: Pericardiectomy is a technically demanding operation associated with significant morbidity, and can be performed with or without cardiopulmonary bypass (CPB). The present study utilized a national cohort to evaluate short-term outcomes of pericardiectomy, stratified by the use of CPB.
Methods: Adults undergoing pericardiectomy were identified in the 2010-2020 Nationwide Readmissions Database. Patients were divided into two groups based on the use of CPB. Concomitant operations included coronary artery bypass grafting, valve surgery, or arrhythmia surgery. The primary outcome was in-hospital mortality while secondary outcomes included complications, length of stay (LOS), and hospitalization costs. Multivariable logistic and linear regression was used to evaluate the impact of CPB on primary and secondary outcomes.
Results: Among 32,245 patients, 26.0% underwent pericardiectomy on CPB. Patients undergoing surgery on CPB were older (60.3 vs 58.8, p<0.001), less commonly female (30.9% vs 43.2%, p<0.001), had a greater burden of chronic diseases (Elixhauser Index 5.4 vs 4.2, p<0.001), and a greater severity of illness subclass (major or severe 77.6% vs 64.5%, p<0.001). Those undergoing pericardiectomy on CPB more frequently had pulmonary hypertension (21.0% vs 10.0%, p<0.001), chronic lung disease (30.2% vs 27.1%, p=0.002), and peripheral vascular disease (16.4% vs 6.3%, p<0.001). Patients requiring CPB more commonly underwent concomitant operations (62.3%% vs 2.8%, p<0.001). Unadjusted mortality rates were higher for surgery with CPB compared to without (7.0% vs 5.6%, p=0.007). Rates of stroke (3.4% vs 1.7%), blood transfusion (32.5% vs 16.3%), tracheostomy (4.1% vs 2.8%), re-exploration (3.8% vs 1.7%), AKI (30.5% vs 20.7%), and dialysis (6.8% vs 4.5%) were greater for those undergoing surgery with CPB (all p<0.001). Patients requiring CPB had longer LOS (16.0 vs 11.9 days, p<0.001), greater hospitalization costs ($92,800 vs $49,300, p<0.001), but similar 30-day readmission rates (17.4% vs 17.6%, p=0.82). After risk-adjustment, CPB was not associated with mortality, tracheostomy, or dialysis. However, CPB remained associated with greater odds of stroke, blood transfusion, re-exploration, and AKI (Figure). In addition, CPB was associated with an increase in costs by $36,700 (95% CI 28,200-45,200) and LOS by 2.4 days (95% CI 1.4-3.4).
Conclusion: Although pericardiectomy on CPB was associated with greater morbidity, mortality was comparable to cases done without CPB. These findings suggest the continued safety of CPB for pericardiectomy when deemed clinically appropriate. Further study of approaches to mitigate morbidity associated with CPB in patients with pericardial disease are warranted.
