Fifteen-year experience with pericardiectomy at a tertiary referral center

Abstract

Purpose Pericardiectomy has traditionally carried relatively high perioperative mortality and morbidity, with few published reports of intermediate- and long- term outcomes. We investigated our 15-year experience performing pericardiectomy at our institution. Methods Retrospective study of all patients who underwent pericardiectomy at our institution between 2005 and 2019. Baseline demographics, intraoperative details, and postoperative outcomes including long-term survival were analyzed. Results Sixty-three patients were included in the study. 66.7% of subjects underwent isolated pericardiectomy while 33.3% underwent pericardiectomy concomitantly with another cardiac surgical procedure. The most common indications for pericardiectomy were constrictive (79.4%) and hemorrhagic (9.5%) pericarditis. Preoperatively, 76.2% of patients were New York Heart Association class II and III, while postoperatively, 71.4% were class I and II. One-, three-, five-, and ten- year overall mortality was 9.5, 14.3, 20.6, and 25.4%, respectively. Overall pericarditis recurrence rate was 4.8%. Conclusion Pericardiectomy carries relatively high overall mortality rates, which likely reflects underlying disease etiology and comorbidities. Patients with prior cardiac intervention, history of dialysis, and immunocompromised state are associated with worse outcomes.

Surgical Treatment of Constrictive Pericarditis

“…Regarding the relationship between mortality and CP etiologies, we observed that RDT CP has the worst prognosis, since in our case it corresponds to 50% of the deaths; this association also coincides with that reported in the literature [ 1 , 8 , 13 ] . On the other hand, IDP CP has the best prognosis [ 4 , 12 ] .…”

“…On the other hand, RDT CP is a less prevalent etiology in most series but with high morbimortality, which we were also able to prove since 50% of our mortality was due to this etiology. Several authors describe radiation as a poor prognostic factor in the development of CP and its subsequent surgical resection [ 1 , 7 , 8 , 13 ] . Bertog et al [ 8 ] describe an average of 11 years (range between 2-20 years) between exposure to radiation and pericardiectomy, in our case it was 18.5 years.…”

“…Among the postoperative intercurrences, the most frequently described was low cardiac output syndrome with an incidence of 35% in our analysis, which coincides with other series [ 3 - 5 , 14 ] . On the other hand, the most serious postoperative complication seems to be acute renal failure requiring hemodialysis with an incidence that varies from 1.8 to 7%; as reported by several authors, renal replacement therapy significantly worsens the prognosis [ 3 , 4 , 7 , 8 , 13 , 14 ] . Our incidence of renal failure was 13%, but no patient required hemodialysis.…”

Advances in Imaging and Targeted Therapies for Recurrent Pericarditis

“…Thus, radical pericardiectomy is preferred. [91][92][93] While pericardiectomy has been considered a high-risk operation with operative mortality of 6% to 10%, [94][95][96] recent reports from specialty centers suggest operative risk is largely dependent on etiology and comorbidities, with operative mortality for idiopathic cases less than 1.5%. 90,97,98…”

Constrictive Pericarditis: A Diagnostic Conundrum

“…Echocardiography is the first-line imaging modality for the diagnosis and invasive hemodynamic measurements are reserved for ambiguous cases [ 3 ]. Pericardiectomy remains the definitive treatment for CP, however, a trial of anti-inflammatory medications is preferred initially [ 4 ]. We present a case of inadequately treated acute pericarditis resulting in constriction necessitating pericardiectomy.…”