Takashi Murashita1, Hartzell V Schaff2, Richard C Daly1, Jae K Oh3, Joseph A Dearani1, John M Stulak1, Katherine S King4, Kevin L Greason1. 1. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. 2. Department of Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota. Electronic address: schaff@mayo.edu. 3. Department of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota. 4. Department of Health Sciences Research, Mayo Clinic, Rochester, Minnesota.
Abstract
BACKGROUND: The purpose of this study was to review the surgical outcomes of pericardiectomy for constrictive pericarditis and to examine risk factors for overall mortality in a contemporary period. METHODS: We reviewed all patients who underwent pericardiectomy for constriction from 1936 through 2013. The investigation included constrictive pericarditis cases confirmed intraoperatively, all other types of pericarditis were excluded; 1,071 pericardiectomies were performed in 1,066 individual patients. Patients were divided into two intervals: a historical (pre-1990) group (n = 259) and a contemporary (1990-2013) group (n = 807). RESULTS: Patients in the contemporary group were older (61 versus 49 years; p < 0.001), more symptomatic (NYHA class III or IV in 79.6% versus 71.2%; p < 0.001), and more frequently underwent concomitant procedures (21.4% versus 5.4%; p < 0.001) compared with those in the historical group. In contrast to the historical cases in which the etiologies of constriction were mostly idiopathic (81.1%), nearly half of contemporary cases had a nonidiopathic etiology (postoperative 32.3%, radiation 11.4%). Although 30-day mortality decreased from 13.5% in the historical era to 5.2% in the contemporary era (p < 0.001), overall survival was similar after adjusting for patient characteristics. Risk factors of overall mortality in the contemporary group included NYHA class III or IV (HR 2.17, p < 0.001), etiology of radiation (HR 3.93, p < 0.001) or postcardiac surgery (HR 1.47, p < 0.001), and need for cardiopulmonary bypass (HR 1.35, p = 0.014). CONCLUSIONS: There was a significant change in disease etiology over the study period. Long-term survival after pericardiectomy is affected by patient characteristics including etiology of constriction and severity of symptoms.
BACKGROUND: The purpose of this study was to review the surgical outcomes of pericardiectomy for constrictive pericarditis and to examine risk factors for overall mortality in a contemporary period. METHODS: We reviewed all patients who underwent pericardiectomy for constriction from 1936 through 2013. The investigation included constrictive pericarditis cases confirmed intraoperatively, all other types of pericarditis were excluded; 1,071 pericardiectomies were performed in 1,066 individual patients. Patients were divided into two intervals: a historical (pre-1990) group (n = 259) and a contemporary (1990-2013) group (n = 807). RESULTS:Patients in the contemporary group were older (61 versus 49 years; p < 0.001), more symptomatic (NYHA class III or IV in 79.6% versus 71.2%; p < 0.001), and more frequently underwent concomitant procedures (21.4% versus 5.4%; p < 0.001) compared with those in the historical group. In contrast to the historical cases in which the etiologies of constriction were mostly idiopathic (81.1%), nearly half of contemporary cases had a nonidiopathic etiology (postoperative 32.3%, radiation 11.4%). Although 30-day mortality decreased from 13.5% in the historical era to 5.2% in the contemporary era (p < 0.001), overall survival was similar after adjusting for patient characteristics. Risk factors of overall mortality in the contemporary group included NYHA class III or IV (HR 2.17, p < 0.001), etiology of radiation (HR 3.93, p < 0.001) or postcardiac surgery (HR 1.47, p < 0.001), and need for cardiopulmonary bypass (HR 1.35, p = 0.014). CONCLUSIONS: There was a significant change in disease etiology over the study period. Long-term survival after pericardiectomy is affected by patient characteristics including etiology of constriction and severity of symptoms.
Authors: Santhosh Regini Benjamin; Aamir Mohammad; Ravi Shankar; Korah Thomas Kuruvilla; Madhu Andrew Philip; Roy Thankachen; Birla Roy Gnanamuthu; Premprasath Kesavan Journal: Indian J Thorac Cardiovasc Surg Date: 2022-02-05
Authors: Jan Berg; Marina Lovrinovic; Nora Baltensperger; Christine K Kissel; Jan Kottwitz; Robert Manka; Dimitri Patriki; Frank Scherff; Christian Schmied; Ulf Landmesser; Thomas F Lüscher; Bettina Heidecker Journal: Open Heart Date: 2019-04-23