Original article
Adult cardiac
Pericardiectomy for Constrictive Pericarditis: 20 Years of Experience at the Montreal Heart Institute

https://doi.org/10.1016/j.athoracsur.2015.02.054Get rights and content

Background

The aim of this study was to evaluate our single-center experience with pericardiectomy for constrictive pericarditis. The main objectives of our analysis were long-term survival, clinical outcome, and identification of risk factors.

Methods

Over a 20-year period, 99 consecutive patients underwent pericardiectomy at the Montreal Heart Institute. The indications for operation were idiopathic pericarditis (61%), postsurgical (13%), infectious (15%), postirradiation (2%), and miscellaneous (9%). Associated procedures were performed in 36% of cases. The duration of symptoms was longer than 6 months in 53% of cases, and two thirds of patients were in New York Heart Association class III or IV.

Results

Hospital mortality was 9% in the whole series and 7.9% in case of isolated pericardiectomy. The patients operated on within 6 months after the onset of symptoms showed a lower risk of mortality. Conversely, preoperative hepatomegaly and concomitant valvular operation were associated with significantly higher mortality on both univariate and multivariate analysis. In cases of isolated pericardiectomy, the outcome was mainly conditioned by associated comorbidities. The long-term survival was satisfactory, and the functional status at follow-up was improved in most cases.

Conclusions

The clinical outcome of pericardiectomy for constrictive pericarditis is still marked by high operative mortality. Nevertheless, surgical treatment is able to improve the functional class in the majority of late survivors. Preoperative clinical conditions and associated comorbidities are crucial in predicting the risk of mortality, and early operation seems to be the most appropriate choice. The most suitable surgical strategy in cases of associated valvular operation remains to be determined.

Section snippets

Study Population and Study Design

From January 1994 through February 2014, 99 consecutive patients underwent total or partial pericardiectomy at the Montreal Heart Institute, and they constitute the subjects of this report. Only the patients in whom the main surgical indication was CP were considered in the study. We also excluded the cases in which the pericardiectomy was an unplanned procedure, performed after an intraoperative finding of CP. The patients' clinical charts were reviewed, and preoperative, intraoperative, and

Preoperative Characteristics

Table 1 shows the preoperative characteristics of patients. In two thirds of cases, CP was idiopathic. The miscellaneous causes of CP were prior chest trauma in 2 patients, malignancy in 1 patient, and myocardial infarction in 6 patients. The duration of symptoms was less than 6 months only in 47% of patients, and the remaining patients had symptoms for longer than 6 months, in some cases years. Two thirds of patients were in NYHA functional class III or IV.

Intraoperative Findings

The patients’ intraoperative

Comment

The clinical outcome of pericardiectomy for CP remains constrained by high operative mortality. Our study has highlighted that some pre-and intra-operative factors, mainly related to the clinical condition of the patients, can adversely affect the short term outcome. However, if patients make it through the operation, the long-term survival and the clinical improvement are excellent in most cases.

Hospital mortality was 9% in our series (7.9% in cases of isolated pericardiectomy and 11.1% in

Cited by (0)

View full text