Key result
TB etiology is linked to ~66% lower mortality versus other etiologies after pericardiectomy for constrictive pericarditis.
Why the study?
Tuberculosis is the most common cause of constrictive pericarditis in the developing world, prompting an evaluation of outcomes after pericardiectomy in these patients.
Does pericardiectomy improve NYHA class and how does mortality compare between tuberculous and other etiologies in patients with constrictive pericarditis?
Systematic Review (n=859)
Does pericardiectomy improve NYHA class and how does mortality compare between tuberculous and other etiologies in patients with constrictive pericarditis?
Relative Risk: 0.34 (95% CI 0.12–1.01)
Absolute Event Rate: 8.7% vs 23.9%
Pericardiectomy for constrictive tuberculous pericarditis is associated with significant improvement in NYHA class and potentially lower mortality compared to other etiologies, though findings are limited by study heterogeneity.
Supports etiology-informed prognosis after pericardiectomy; leaves open whether the association reflects biology or residual confounding.
Tuberculosis (TB) is the most common etiology of constrictive pericarditis in the developing world. In this study, we collected currently available data to evaluate the outcomes following pericardiectomy in patients with constrictive tuberculous pericarditis. We retrieved electrical databases, including PubMed and PubMed Central, from 1985 AD and onwards. We included articles that had more than 80% TB as the etiology and articles with mixed etiologies. Pooled analysis was done in Review Manager (RevMan) version 5.2 (The Nordic Cochrane Centre, Copenhagen). and Stata Statistical Software, Release 16 ( StataCorp LLC, College Station, TX). We compared the mortality in patients after pericardiectomy due to TB with other etiologies. In-hospital mortality versus one-year mortality was analyzed in studies with constrictive pericarditis of mixed etiologies. We also compared pre-operative New York Heart Association (NYHA) grade to post-operative NYHA grade one year after pericardiectomy. We calculated the pooled mean of postoperative hospital stay, postoperative intensive care unit (ICU) stay, and in-hospital mortality. A total of 12 articles and 859 patients were included in the final analysis. Pericardiectomy was performed mostly on middle-aged men with or without previous comorbidity. Total pericardiectomy was the preferred surgical procedure performed on a mean of 93% of patients. The pooled analysis shows a significant decrease in all-cause mortality in patients with TB as compared to other etiologies (pooled risk ratios (RR) 0.34 CI [0.12,1.01] I2 = 61%) and a lower but insignificant in-hospital mortality in comparison to one-year mortality in studies with mixed etiologies (RR 0.59 [0.11,3.11] I2= 61%). There was a significant improvement in the NYHA grade of the patients one year following pericardiectomy (RR 8.04, CI [5.20,12.45], I2= 0%). The mean postoperative hospital stay and the postoperative ICU stay were calculated and reported in terms of days. The mean postoperative hospital stays in studies with more than 80% of TB cases is 13.34 (10.21, 16.47) with a mean standard deviation of 4.46 (2.87, 6.05). The mean postoperative ICU stay is 1.93 (1.47, 2.39), with a mean standard deviation of 3.26 (2.51, 4.00), and the mean in-hospital mortality is 0.07 (0.02, 0.12). Similarly, the mean postoperative hospital stay in studies with mixed etiologies is 19.40 (11.93, 26.87) with a mean standard deviation of 8.26 (4.21, 12.52). The mean postoperative ICU stay is 3.52 (1.93, 5.10) with a mean standard deviation of 2.34 (1.36, 3.32). The mean in-hospital mortality is 0.06 (0.04, 0.08). There is significant heterogeneity along with a number of methodological concerns, and therefore, generalization of the data should be done with caution, and a randomized controlled trial in the future may be beneficial.
No takes yet. Share an insight, caveat, or question.
Yadav et al. (2021) conducted a systematic review in Constrictive pericarditis (n=859). Tuberculosis etiology vs. Other etiologies was evaluated on All-cause mortality (RR 0.34, 95% CI 0.12-1.01). Tuberculosis etiology was associated with a decrease in all-cause mortality compared to other etiologies in patients undergoing pericardiectomy for constrictive pericarditis (RR 0.34).
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: