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Constrictive pericarditis is an uncommon disease with multiple etiologies that can lead to disabling symptoms and severe heart failure with poor quality of life. Its cause has changed over the years with idiopathic being the most common diagnosis in the western world, while tuberculosis remains most prevalent in the developing one. This study examines our experience with constrictive pericarditis treated with pericardiectomy, and attempts to identify factors that predict poor long-term survival.
A retrospective review was performed on the database of patients that underwent partial or complete pericardiectomy for constrictive pericarditis between 1997 and 2012. Demographic, comorbid, operative and outcome data were analyzed.
A total of 36 patients underwent pericardiectomy for constrictive pericarditis at our institution over the last 15 years. The mean age was 59.5 years and there were 25 males (68%). The most common etiologies were idiopathic (n=20), post-operative (n=11), and post-radiation (n=3). Complete pericardiectomy was performed in 36 patients and incomplete in one patient due to dense adhesions. Eleven cases were re-operations, 15 required concomitant procedures, and 15 needed cardiopulmonary bypass. There were two re-operations for bleeding, and no intra-operative deaths. The average pre-operative cardiac index was 2.4L/min/m2, while post-operatively was 4.1L/min/m2. Overall 30-day, 1-year, 5-year, 10-year, and 15-year survival rates were 100%, 97.2%, 94.6%, 86.5%, and 78.3%, respectively. On multi-variate analysis, post-radiation etiology (hazard ratio 1.9, p = 0.47), high pre-operative total bilirubin (hazard ratio 6.8, p = 0.27), and high pre-operative creatinine (hazard ratio 3.1, p = 0.08) were associated with increased long-term mortality.
Constrictive pericarditis can be a disabling disease that needs aggressive surgical treatment before severe symptoms of heart failure develop. Pericardiectomy can improve significantly the cardiac performance. Post-radiation pericarditis is a clear risk factor for decreased long-term survival, along with pre-operative liver failure and renal insufficiency.
Poster Sessions, Expo North
Sunday, March 10, 2013, 3:45 p.m.-4:30 p.m.
Session Title: Pericardial Diseases
Abstract Category: 23. Pericardial/Myocardial Disease
Presentation Number: 1250-147
- 2013 American College of Cardiology Foundation