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Radical pericardiectomy for chronic constrictive pericarditis

Shahab Nozohoor1, Maria Johansson1, Bansi Koul1

  • 1Department of Cardiothoracic Surgery, Skane University Hospital, Clinical Sciences, Lund University, Lund, Sweden.

Journal of Cardiac Surgery
|May 16, 2018
PubMed

Insights

Radical pericardiectomy significantly improves survival and functional class in constrictive pericarditis patients compared to sub-total pericardiectomy. This procedure offers better long-term outcomes for patients with this heart condition.

Area of Science:

  • Cardiology
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Chronic constrictive pericarditis impairs cardiac function and patient quality of life.
  • Pericardiectomy is a surgical option to treat constrictive pericarditis.
  • The extent of pericardiectomy (radical vs. sub-total) may impact patient outcomes.

Purpose of the Study:

  • To compare the efficacy of radical pericardiectomy versus sub-total pericardiectomy.
  • To evaluate the impact of surgical approach on patient survival and functional status.
  • To assess long-term outcomes in patients with chronic constrictive pericarditis.

Main Methods:

  • Retrospective study of 41 patients with chronic constrictive pericarditis from 1991-2016.
  • Patients were divided into two groups: radical pericardiectomy (n=24) and sub-total pericardiectomy (n=17).
  • Outcomes assessed included early and long-term survival, New York Heart Association (NYHA) functional class, and left ventricular ejection fraction, with 100% follow-up.

Main Results:

  • Radical pericardiectomy demonstrated significantly higher 10-year survival rates (94%) compared to sub-total pericardiectomy (55%) (P=0.014).
  • In the idiopathic subgroup, radical pericardiectomy also showed increased long-term survival (P=0.001).
  • Postoperative functional improvement was superior with radical pericardiectomy, with 85-94% of patients achieving NYHA class I or II up to 25 years versus 53-63% for sub-total pericardiectomy.

Conclusions:

  • Radical pericardiectomy is associated with superior long-term survival in patients with chronic constrictive pericarditis.
  • The radical approach leads to better clinical functional improvement compared to sub-total pericardiectomy.
  • This study supports radical pericardiectomy as the preferred surgical strategy for chronic constrictive pericarditis.
Abstract

Keywords:
cardiac functioncardiac reoperationoutcomespericardium

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