Contemporary Etiologies, Risk Factors, and Outcomes After Pericardiectomy

Abstract

Background The leading causes of constrictive pericarditis have changed over time leading to a commensurate change in the indications and complexity of surgical pericardiectomy. We evaluated our single-center experience to define the etiologies, risk factors, and outcomes of pericardiectomy in a modern cohort. Methods We retrospectively reviewed our institutional database for all patients who underwent total or partial pericardiectomy. Demographic, co-morbid, operative, and outcome data were evaluated. Survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models examined risk factors for mortality. Results From 1995–2010, 98 adults underwent pericardiectomy for constrictive disease. The most common etiologies were idiopathic (n=44), postoperative (n=30), and post-radiation (n=17). Total pericardiectomy was performed in 94 cases, most commonly through a sternotomy (n=93). Thirty-three cases were redo sternotomies, 34 underwent a concomitant procedure, and 34 required cardiopulmonary bypass. Overall in-hospital, 1-year, 5-year, and 10-year survival rates were 92.9%, 82.5%, 64.3%, and 49.2%, respectively. Survival differed sharply by etiology with idiopathic, postoperative, and post-radiation 5-year survivals of 79.8%, 55.9%, and 11.0%, respectively (p<0.001). On multivariable analysis, only the need for cardiopulmonary bypass (HR: 21.2, p=0.02) was predictive of 30-day mortality while post-radiation etiology (HR: 3.19, p=0.02) and hypoalbuminemia (HR: 0.57, p=0.03) were associated with increased 10-year mortality. Conclusions Although survival varies significantly by etiology, pericardiectomy continues to be a safe operation for constrictive pericarditis. Post-radiation pericarditis and hypoalbuminemia are significant risk factors for decreased long-term survival.

Long-Term Clinical Outcomes and Prognostic Factors After Pericardiectomy for Constrictive Pericarditis in a Japanese Population

“…Long-Term Prognosis After Pericardiectomy are related to the underlying etiology. 4-7, 16 Bertog et al 5 reported that survival at a median follow-up of 6.9 years was 63% among 163 patients undergoing pericardiectomy. Idiopathic CP was related to the best survival (88%), followed by post-CS CP (66%) and post-radiation CP (27%).…”

Surgical Treatment of Constrictive Pericarditis

“…9 Different surgical approaches and techniques, especially median sternotomy versus lateral thoracotomy, partial versus total pericardiectomy, and the need for CPB continue to be debated. 4,6,10,16 Generally, the median sternotomy approach enables a more radical clearance of pericardium overlying the right atrium and venae cavae. 17,18 The left anterolateral thoracotomy approach should be preferred in cases of purulent pericarditis and effusive-constricted pericarditis because of concomitant pyothorax and the risk of sternal infection.…”

Pericarditis constrictiva como presentación grave e infrecuente de lupus eritematoso sistémico: reporte de un caso y revisión de la literatura

“…El compromiso pericárdico crónico por LES ha sido comunicado anecdóticamente [1][2][3][4][5] , siendo mucho más frecuente el derrame pericárdico como manifestación de serositis aguda en el contexto de LES activo. No obstante ello, en este caso se llegó a la determinación de LES como unidad diagnóstica etiológica, a partir del estudio de un síndrome edematoso y hallazgo de constricción pericárdica, llamando la atención sobre dicha infrecuente asociación.…”

“…La biopsia pericárdica puede revelar inflamación crónica con predominio de mononucleares, aunque lo más común es fibrosis 18 . La PC por LES es extremadamente infrecuente, existiendo sólo 5 casos publicados desde 1965 [1][2][3][4][5] . El diagnóstico de PC se confirmó con cateterismo cardiaco y las biopsias pericárdicas mostraron fibrosis e inflamación crónica, sin granulomas.…”