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DOI: 10.1055/s-2007-967461
Constrictive pericarditis: pre-operative risk adjusted survival after total pericardiectomy
Aims: Constrictive pericarditis is the result of a spectrum of primary cardiac and noncardiac conditions. This retrospective study was designed to compare the association of etiology of constrictive pericarditis, and other clinical variables with long-term survival after total pericardiectomy.
Methods: A total of 54 patients who underwent pericardiectomy for constrictive pericarditis between 1988–2006 at a single surgical center were studied. Constrictive pericarditis was confirmed by the surgical report. Long term follow-up was 7.5 (0.5–18) years.
Results: Etiology of constrictive pericarditis was idiopathic in 27 patients (50%), prior cardiac surgery in 12 patients (24%), radiation treatment in 4 patients (7.5%), uremia in 4 patients (7.5%) myocardial infarction in 4 patients (7.5%) and tuberculosis in 2 patients (3.5%). Perioperative mortality was 8%. 75% of patients were in NYHA III-IV stadium which significantly improved in long term survivors (95% in NYHA I-II). Idiopathic constrictive pericarditis had the best prognosis (5-year Kaplan-Meier survival: 81%), followed by postsurgical (50%) and postradiation pericarditis (no survivors after 5 years). Tuberculosis, myocardial infarction and uremia have comparable survival with idiopathic etiology. In addition, preoperative NYHA IV class, was associated with significantly lower long term survival (50% vs. 80%). Neither preoperative comorbidities nor associated cardiac surgical procedures (11 valve replacement, 7 CABG) showed any impact on long term survival.
Conclusions: Long-term survival after pericardiectomy for constrictive pericarditis is related to underlying etiology, and overall clinical condition. The relatively good survival with idiopathic constrictive pericarditis emphasizes the safety of pericardiectomy in this subgroup.