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Current indications, risks, and outcome after pericardiectomy
P A DeValeria1, W A Baumgartner, A S Casale
1Johns Hopkins Medical Institutions, Baltimore, Maryland.
Insights
Pericardiectomy offers low mortality and good long-term survival for patients with pericardial effusion or constriction. This surgery effectively relieves symptoms, especially pain, in patients unresponsive to medical treatment.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Cardiac Surgery
Background:
- Pericardiectomy is a surgical procedure to remove part or all of the pericardium.
- Indications include pericardial effusion and constriction, with varying outcomes.
- Previous limited pericardial procedures may necessitate formal pericardiectomy.
Purpose of the Study:
- To evaluate the outcomes of pericardiectomy for effusive and constrictive pericardial disease.
- To identify predictors of survival after pericardiectomy.
- To assess the efficacy of pericardiectomy in relieving symptoms, particularly pain.
Main Methods:
- Retrospective analysis of 60 patients undergoing pericardiectomy between 1980 and 1990.
- Data collected on indications, operative approach, mortality, and follow-up.
- Cox proportional hazards regression analysis used to identify survival predictors.
Main Results:
- Operative mortality was 4.2% for effusion and 5.6% for constriction.
- Actuarial survival at 10 years was 59.8%.
- History of malignancy, prior pericardial procedure, and NYHA class IV predicted poor survival.
- All patients operated on for effusion with pain were alive with improved function.
Conclusions:
- Pericardiectomy is associated with low mortality and good long-term survival.
- The procedure improves functional capacity and relieves symptoms, especially refractory pain.
- Predictors of poor survival include malignancy, prior surgery, and advanced heart failure class.
Abstract:
A retrospective analysis of the records of 60 patients who underwent pericardiectomy over a 10-year period (1980 to 1990) at The Johns Hopkins Hospital was performed. Indications for operation were effusive disease in 24 patients and constriction in 36 patients. Six patients (10%) with pericardial effusion had pain as the primary symptom necessitating intervention. The operative approach for pericardiectomy was median sternotomy in 52 patients (4 patients required cardiopulmonary bypass) and left anterior thoracotomy in 8 patients. Nine patients (5 with constriction and 4 with effusion) with a prior limited pericardial procedure required formal pericardiectomy. The operative mortality rate for pericardial effusion and constriction was 4.2% and 5.6%, respectively. Follow-up (median follow-up, 56.9 +/- 38.2 months) was obtained on 56 patients (93.3%). Actuarial survival at 1 year, 5 years, and 10 years for all patients was 82.1% +/- 5.1%, 71.7% +/- 6.7%, and 59.8% +/- 12.2%, respectively. A Cox proportional hazards regression analysis was performed using 20 clinical variables. A history of malignancy, previous pericardial procedure, and preoperative New York Heart Association class IV were found to be predictors of poor survival. All patients who underwent operation primarily for effusion with associated pain are alive and have improved functional capacity without steroid use. We conclude that pericardiectomy can be performed with low mortality and can result in good long-term survival and improved functional capacity. Patients who are seen primarily with pain refractory to steroid therapy can be relieved of symptoms with operation.