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Fifteen-Year Experience and Outcomes of Pericardiectomy for Constrictive Pericarditis.
MedLine Citation:
PMID:  24750218     Owner:  NLM     Status:  Publisher    
BACKGROUND AND AIM: Constrictive pericarditis has multiple etiologies and can lead to disabling symptoms and severe heart failure with poor quality of life. Surgical pericardiectomy is the cornerstone of management. All patients undergoing pericardiectomy at our institution were reviewed with the goal of analyzing preoperative and intraoperative factors that may be associated with long-term outcomes.
METHODS: A retrospective review of our cardiac surgery database identified all patients who underwent pericardiectomy for constrictive pericarditis between 1997 and 2012. Demographic, comorbidity, operative, and outcome data were analyzed.
RESULTS: Thirty-six patients underwent pericardiectomy for constrictive pericarditis over 15 years. Etiologies included idiopathic (n = 20, 55.6%), postoperative (n = 11, 30.5%), postradiation (n = 3, 8.3%), and tuberculosis (n = 2, 5.6%). Total pericardiectomy was performed in 35 patients. The average preoperative cardiac index was 2.6 L/min/m(2) with a significant increase to 3.1 L/min/m(2) noted in the immediate postoperative period (p = 0.03). There were no perioperative mortalities. The 1-year, 5-year, 10-year, and 15-year survival rates were 97.2%, 94.6%, 86.5%, and 78.3%, respectively. On multivariate analysis, preoperative heart failure (hazard ratio 2.2, p = 0.06), elevated preoperative total bilirubin (>2.7 mg/dL, hazard ratio 6.8, p = 0.02), and elevated creatinine (>1.4 mg/dL, hazard ratio 3.1, p = 0.05) were risk factors for increased long-term mortality. Kaplan-Meier survival analysis showed a significant decrease in overall survival associated with postradiation etiology (p = 0.05).
CONCLUSIONS: Pericardiectomy can be performed with low mortality and immediate improvement in hemodynamics. Those patients with compromised cardiac output, abnormal hepatic or renal function, or with previous radiation therapy have reduced long-term survival.
Dimitrios Avgerinos; Yuri Rabitnokov; Berhane Worku; Siyamek Neragi; Leonard N Girardi
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2014-4-18
Journal Detail:
Title:  Journal of cardiac surgery     Volume:  -     ISSN:  1540-8191     ISO Abbreviation:  J Card Surg     Publication Date:  2014 Apr 
Date Detail:
Created Date:  2014-4-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8908809     Medline TA:  J Card Surg     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Copyright Information:
© 2014 Wiley Periodicals, Inc.
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