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Review
. 2021 Sep 24;13(9):e18252.
doi: 10.7759/cureus.18252. eCollection 2021 Sep.

Pericardiectomy for Constrictive Tuberculous Pericarditis: A Systematic Review and Meta-analysis on the Etiology, Patients' Characteristics, and the Outcomes

Shikha Yadav  1   2 , Suchitra Shah  2 , Zafar Iqbal  3   4 , Mohammed G Alharbi  2   5   6 , Harjeevan S Kalra  2 , Megha Suri  7 , Nitin Soni  8 , Nkiruka Okpaleke  9 , Pousette Hamid  10
Affiliations
Review

Pericardiectomy for Constrictive Tuberculous Pericarditis: A Systematic Review and Meta-analysis on the Etiology, Patients' Characteristics, and the Outcomes

Shikha Yadav et al. Cureus. .

Abstract

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.

Keywords: constrictive pericarditis; constrictive tuberculous pericarditis; pericardiectomy; pericarditis; tuberculosis.

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Conflict of interest statement

The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. The Newcastle-Ottawa scale for evaluation of methodological quality and bias of studies.
Figure 2
Figure 2. PRISMA flow diagram-2020 for systematic reviews which include searches of databases and registers only.
PRISMA - Preferred Reporting Item for Systematic Reviews and Meta-analysis; n - number of articles
Figure 3
Figure 3. All-cause mortality after pericardiectomy in patients with constrictive tuberculous pericarditis and other etiologies.
TB Events: Mortality after pericardiectomy in patients with constrictive pericarditis with tuberculosis as etiology. Other Events: Mortality after pericardiectomy in patients with constrictive pericarditis with etiologies other than tuberculosis. The Cochran-Mantel-Haenszel method and the random-effects model were used to calculate the pooled risk ratio. M-H - Mantel-Haenszel Test; Tau2 - Tau-squared test for random effects model; Chi2 - Chi-squared test; df - degree of freedom; I2 - I2 test for heterogeneity; Z - Standard score References [2,8,10]
Figure 4
Figure 4. In-hospital mortality versus one-year mortality post-pericardiectomy in patients with constrictive pericarditis.
In-hospital mortality events: Mortality in patients within 30 days of pericardiectomy for constrictive pericarditis. One-year mortality Events: Mortality in patients within one year of pericardiectomy for constrictive pericarditis. The Cochran-Mantel-Haenszel method and the random-effects model were used to calculate the pooled risk ratio. M-H - Mantel-Haenszel Test; Tau2 - Tau-squared test for random effects model; Chi2 - Chi-squared test; df - degree of freedom; I2 - I2 test for heterogeneity; Z - Standard score References [2,9,13,15]
Figure 5
Figure 5. Pre-operative NYHA grade III and IV versus post-operative NYHA grade III and IV after one year in patients with constrictive tuberculous pericarditis.
Pre-op NYHA grade 3/4: Pre-operative New York Heart Association (NYHA) grades III and IV in patients with constrictive tuberculous pericarditis. Post-op NYHA grade 3/4: Post-operative NYHA grades III and IV after one year in patients with constrictive tuberculous pericarditis. The Cochran- Mantel- Haenszel method and the random-effects model were used to calculate the risk ratio. M-H - Mantel-Haenszel Test; Tau2 - Tau-squared test for random effects model; Chi2 - Chi-squared test; df - degree of freedom; I2 - I2 test for heterogeneity; Z - Standard score References [7,12,16]
Figure 6
Figure 6. Mean of postoperative hospital stay for studies with more than 80% of TB cases.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance References [3,7,12,14,16]
Figure 7
Figure 7. Mean of the standard deviation for the postoperative hospital stay for studies with more than 80% of TB cases.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean standard deviation. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [3,7,12,14,16]
Figure 8
Figure 8. Mean of postoperative ICU stay in studies with more than 80% of TB cases.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [3,7,10,12,14,16]
Figure 9
Figure 9. The mean standard deviation for postoperative ICU stay for studies with more than 80% of TB cases.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [3,7,10,12,14,16]
Figure 10
Figure 10. Mean in-hospital mortality in studies with more than 80% TB cases.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [3,7,10,12,14,16]
Figure 11
Figure 11. Funnel plot for studies with more than 80% of TB cases.
References [3,7,10,12,14,16]
Figure 12
Figure 12. Mean of postoperative hospital stay in studies with mixed etiologies.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [9,11,13,15]
Figure 13
Figure 13. Mean of the standard deviation of postoperative hospital stay in studies with mixed etiologies.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [9,11,13,15]
Figure 14
Figure 14. Mean of postoperative ICU stay in studies with mixed etiologies.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [9,11,13,15]
Figure 15
Figure 15. Mean of the standard deviation of postoperative ICU stay in studies with mixed etiologies.
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [9,11,13,15]
Figure 16
Figure 16. Mean in-hospital mortality in studies with mixed etiologies
Random-effects DerSimonian-Laird model was used to calculate the pooled mean. τ2 - Hotelling's t-squared statistic; H2 - H2 test; θ - Vector of parameters of a probability distribution; τ: Between study variance; I2 - I2 test for heterogeneity References [2,8,9,11,13,15]
Figure 17
Figure 17. Funnel plot for studies with mixed etiologies.
References [8,9,11,13,15]
Figure 18
Figure 18. Types of pericardiectomy performed on the overall patients included in our study.
See this image and copyright information in PMC

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