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Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis

Dimitrios Avgerinos1, Yuri Rabitnokov, Berhane Worku

  • 1Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.

Journal of Cardiac Surgery
|April 23, 2014
PubMed

Insights

Surgical pericardiectomy for constrictive pericarditis offers low mortality and improves hemodynamics. However, preoperative heart failure, elevated bilirubin, or creatinine levels, and postradiation etiology are associated with reduced long-term survival.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Thoracic Surgery

Background:

  • Constrictive pericarditis presents diverse etiologies and can lead to severe heart failure.
  • Surgical pericardiectomy is the primary treatment for constrictive pericarditis.
  • Understanding factors influencing long-term outcomes after pericardiectomy is crucial for patient management.

Purpose of the Study:

  • To analyze preoperative and intraoperative factors associated with long-term outcomes in patients undergoing pericardiectomy for constrictive pericarditis.
  • To evaluate the efficacy and safety of surgical pericardiectomy.
  • To identify predictors of mortality after pericardiectomy.

Main Methods:

  • Retrospective review of a cardiac surgery database from 1997 to 2012.
  • Inclusion of all patients who underwent pericardiectomy for constrictive pericarditis.
  • Analysis of demographic, comorbidity, operative, and outcome data.

Main Results:

  • Thirty-six patients underwent pericardiectomy; common etiologies included idiopathic (55.6%), postoperative (30.5%), and postradiation (8.3%).
  • Pericardiectomy resulted in a significant increase in cardiac index (2.6 to 3.1 L/min/m², p=0.03) with no perioperative mortality.
  • Long-term survival rates at 1, 5, 10, and 15 years were 97.2%, 94.6%, 86.5%, and 78.3%, respectively.
  • Multivariate analysis identified preoperative heart failure, elevated total bilirubin (>2.7 mg/dL), and elevated creatinine (>1.4 mg/dL) as risk factors for mortality.
  • Postradiation etiology was associated with significantly decreased overall survival (p=0.05).

Conclusions:

  • Pericardiectomy is a safe procedure with low mortality and immediate hemodynamic improvement for constrictive pericarditis.
  • Compromised cardiac output, abnormal hepatic or renal function, and prior radiation therapy are associated with reduced long-term survival.
  • Identifying high-risk patients preoperatively can guide management and improve long-term outcomes.
Abstract

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