Contemporary etiologies, risk factors, and outcomes after pericardiectomy

Timothy J. George, George J. Arnaoutakis, Claude A. Beaty, Arman Kilic, William A. Baumgartner, John Conte

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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.

Original languageEnglish (US)
Pages (from-to)445-451
Number of pages7
JournalAnnals of Thoracic Surgery
Volume94
Issue number2
DOIs
Publication statusPublished - Aug 1 2012

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All Science Journal Classification (ASJC) codes

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

George, T. J., Arnaoutakis, G. J., Beaty, C. A., Kilic, A., Baumgartner, W. A., & Conte, J. (2012). Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Annals of Thoracic Surgery, 94(2), 445-451. https://doi.org/10.1016/j.athoracsur.2012.03.079