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. 2012 Aug;94(2):445-51.
doi: 10.1016/j.athoracsur.2012.03.079. Epub 2012 May 22.

Contemporary etiologies, risk factors, and outcomes after pericardiectomy

Timothy J George  1 , George J Arnaoutakis, Claude A Beaty, Arman Kilic, William A Baumgartner, John V Conte
Affiliations

Contemporary etiologies, risk factors, and outcomes after pericardiectomy

Timothy J George et al. Ann Thorac Surg. 2012 Aug.

Abstract

Background: The leading causes of constrictive pericarditis have changed over time leading to a commensurate change in the indications and complexity of surgical pericardiectomy. We evaluated our single-center experience to define the etiologies, risk factors, and outcomes of pericardiectomy in a modern cohort.

Methods: We retrospectively reviewed our institutional database for all patients who underwent total or partial pericardiectomy. Demographic, comorbid, operative, and outcome data were evaluated. Survival was assessed by the Kaplan-Meier method. Multivariable Cox proportional hazards regression models examined risk factors for mortality.

Results: From 1995 to 2010, 98 adults underwent pericardiectomy for constrictive disease. The most common etiologies were idiopathic (n=44), postoperative (n=30), and post radiation (n=17). Total pericardiectomy was performed in 94 cases, most commonly through a sternotomy (n=93). Thirty-three cases were redo sternotomies, 34 underwent a concomitant procedure, and 34 required cardiopulmonary bypass. Overall in-hospital, 1-year, 5-year, and 10-year survival rates were 92.9%, 82.5%, 64.3%, and 49.2%, respectively. Survival differed sharply by etiology with idiopathic, postoperative, and post-radiation 5-year survivals of 79.8%, 55.9%, and 11.0%, respectively (p<0.001). On multivariable analysis, only the need for cardiopulmonary bypass (hazard ratio [HR]: 21.2, p=0.02) was predictive of 30-day mortality while post-radiation etiology (HR: 3.19, p=0.02) and hypoalbuminemia (HR: 0.57, p=0.03) were associated with increased 10-year mortality.

Conclusions: Although survival varies significantly by etiology, pericardiectomy continues to be a safe operation for constrictive pericarditis. Post-radiation pericarditis and hypoalbuminemia are significant risk factors for decreased long-term survival.

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Conflict of interest statement

Conflicts: The authors have no relevant conflicts.

Figures

Figure 1
Figure 1
Etiologic distribution of pericardiectomy cases by era. Idiopathic etiology is depicted by the solid black bars. Postoperative etiology is depicted by shaded red bars. Post-radiation etiology is depicted by shaded blue bars. P-value determined by chi-square test.
Figure 2
Figure 2
10-year Kaplan-Meier survival for all pericardiectomy patients.
Figure 3
Figure 3
Kaplan-Meier survival stratified by etiology of pericarditis. Idiopathic etiology is depicted with a solid black line. Postoperative etiology is depicted with a dashed red line. Post-radiation etiology is depicted with a dashed blue line. P-value determined by the log-rank test.
See this image and copyright information in PMC

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