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CARDIOVASCULAR JOURNAL OF AFRICA • Volume 30, No 5, September/October 2019
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AFRICA
elevated pulmonary pressure were shown to predict pre-operative
mortality rate.
Similarly, we found no difference in the peri-operative and
postoperative outcomes between HIV-positive and -negative
patients. At the six-week follow-up visit, most patients in our
series showed significant improvement in NYHA class (
p
≤
0.001) (Table 3), with improvement of at least one functional
class to NYHA I (78.6%) and II (21%). This finding is consistent
with reports by Mutyaba
et al
.
2
and Tetty
et al
.
20
Furthermore,
ejection fraction was preserved in both HIV-positive and
-negative subjects.
Although our in-hospital peri-operative mortality rate of 5.7%
is higher than the 3.7% reported by Fennel
et al
.
12
in the pre-HIV
era, it is consistent with the majority of series worldwide.
6,9,11-14,18
It is much lower than the 14% mortality rate found by Mutyaba
et al
.
2
in their series, possibly because our HIV-positive patients
were virally suppressed on treatment.
Peri-operative complications in our study appeared to be more
common in HIV-positive patients undergoing pericardiectomy.
Furthermore, complete pericardiectomy was less likely to be
achieved in HIV-positive (
n
=
9, 50%) compared to -negative
patients (
n
=
37, 71%). Whether this was due to the inflammatory
process, with greater anatomical distortion making surgery more
difficult, is not clear.
Study limitations
Our study has limitations related to its retrospective design,
including a number of patients who were lost to follow up
while awaiting surgical pericardiectomy. We were able to obtain
survival status in most patients and were able to show that a
number of subjects died while awaiting surgery. Furthermore,
long-term patient follow up was often not possible because many
patients were from rural areas and had difficulty in accessing
the clinic. Based on the available patient records we could only
accurately comment on in-patient peri-operative mortality rate
and the early six-week follow-up visit after surgery. Furthermore,
in this study the diagnosis of constriction was made clinically and
supported by echocardiographic findings. Although Doppler
echocardiographic parameters (restrictive pattern) to confirm
pericardial constriction were not measured, the diagnosis was
confirmed in all subjects who underwent surgery for pericardial
constriction.
Conclusion
The findings of this study have important clinical implications.
Without surgery, constrictive pericarditis is associated with a
high mortality rate. Our study emphasises the benefits of surgery
in patients who do not respond to anti-tuberculous therapy.
Over a third of patients with constriction are HIV-positive in a
developing country. Although HIV infection is associated with
a higher in-hospital complication rate, peri-operative mortality
rate is unaffected in subjects who are on antiretroviral treatment
and are virologically suppressed.
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