Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy

Abstract

Long-term survival after pericardiectomy for CP is related to underlying etiology, LV systolic function, renal function, serum sodium, and PAP. The relatively good survival with idiopathic CP emphasizes the safety of pericardiectomy in this subgroup.

Results of pericardiectomy for constrictive pericarditis

“…This result was attributed to the detrimental effects of radiation on cardiac structures, including premature coronary artery disease and myocardial fibrosis. Moreover, severe concomitant mediastinal fibrosis precluding complete resection of the diseased pericardium and the higher risk for reconstruction in this subgroup of patients were responsible for the unfavorable outcome [4]. In the present study, none of the patients had postradiation CP and only one had postsurgical CP.…”

“…In a study by Bertog et al, in contrast to the patients with idiopathic CP, a higher operative mortality was reported after pericardiectomy performed because of postradiation and postsurgical CP. It was claimed that preoperative cardiac failure in these subgroups was not only related to constriction, but also to the concomitant myocardial atrophy secondary to the underlying etiology and that the two together accounted for a higher mortality rate in these subgroups of patients [4,9]. Moreover, it has been reported in several studies that while the long-term survival of patients with idiopathic CP, and those with CP of miscellaneous etiologies, after pericardiectomy was excellent, patients with postradiation CP did the poorest [6,27].…”

“…It has been shown that presence of severe functional impairment (NYHA III-IV), pericardial calcification, hepatomegaly, renal failure, and pulmonary hypertension are predictors of unfavorable outcome after pericardiectomy [4,5,34]. All ofthese preoperative variables are thought to be the result of advanced disease at the time of pericardiectomy.…”

“…It is a rarely performed procedure and the reported post-pericardiectomy mortality rate varies from 6 to 16 % [2]. Studies on the impact of several patient-related variables such as etiology, severity of systemic venous congestion, and pericardial calcification on early and late survival and on the recurrence of CP have yielded controversial findings [1,[4][5][6]. The goal of this study was to present our experience with pericardiectomy and identify the predictors of early and late outcome after the procedure.…”

Eine seltene Ursache der Rechtsherzinsuffizienz

“…Die Ätiologie ist vielschichtig: Etwa die Hälfte der Fälle ist "idiopathisch", weitere 36% der Fälle treten nach herzchirurgischen Eingriffen auf. Weitere häufige Ursachen sind eine stattgehabte thorakale Strahlentherapie, Infektion, Urämie, Traumata, Autoimmunerkrankungen und Schrittmacher-/Kardioverter-Defibrillator-Implantationen [1].…”