Outcome of subtotal pericardiectomy for constrictive pericarditis - Lessons from a single centre experience

Egzon Memedi (Düsseldorf)1, B. Ramadani (Düsseldorf)1, I. Tudorache (Zürich)2, P. Rellecke (Düsseldorf)1, D. Stadnik (Düsseldorf)1, H. Aubin (Düsseldorf)1, A. Lichtenberg (Düsseldorf)1, M. Scherner (Düsseldorf)1

1Universitätsklinikum Düsseldorf Klinik für Herzchirurgie Düsseldorf, Deutschland; 2UniversitätsSpital Zürich Herzchirurgie Zürich, Schweiz


Objectives: Constrictive pericarditis (CP) is a rare disease and pericardiectomy often represents the only curative treatment option. The aim of the present study was to analyze data of patients who underwent pericardiectomy with regard to a) patients characteristics, b) short and long term outcome and c) to identify possible risk factors for 30 day- and long-term mortality.

Methods: A total of 30 patients who underwent surgery for CP at our institution in consecutive 12 years were included in this study. CP was diagnosed preoperatively via cardiac catheterization and echocardiography and was confirmed intraoperatively.

The mean age was 61,2±10,4 years. 24 patients (80%) were male. Etiology of CP was idiopathic in 14 patients (46,7%) and miscellaneous in 16 patients (53,3%). 18 patients (60%) showed a CP calcarea. Preoperative NYHA stadium was 2,9±0,6%. 6 patients (20%) had elevated bilirubin levels before surgery (range 1,38-3,04), 8 patients (26,7%) had a kidney insufficiency, 5 patients (16,7%) had a chronic obstrutive pulmonary disease and and 11 patients (36,7%) were with atrial fibrillation.
All patients (n=30) underwent subtotal pericardiectomy. 26 patients (86,7%) were treated off pump, 4 patients (13,3%%) underwent pericardiectomy with cardiopulmonary bypass due to need for concomitant cardiac procedures. Overall 30 day mortality was 3,3%. The most common complications were acute renal failure (20%) and low cardiac output (13,3%) with need for extracorporal life support (10%). Median length of ICU stay was 2 days (range 1 – 34) and median hospital stay was 11 days (range 5-41). Mean follow up among survivors was 5,5±3,7 years. 1-year, 3-year and 5-year survival rates were 96,7%, 92,9% and 90,5% respectively.  Survival rates after 7 and 10 years were 80% and 66,7% respectively. NYHA stadium improved during follow up with a NYHA stadium of 1,4±0,7.  Risk factors for diminished 30-day and long-term survival appeared to be atrial fibrillation (HR 1,8; p<0.05), male gender (HR 1,6, p<0.05) and need for concomitant surgical procedures (HR 1,9; p<0.05).  

Constrictive pericarditis can be sufficiently treated with subtotal pericardiectomy and without need for cardiopulmonary bypass if no additional cardiac procedure is required. Surgical therapy leads to significant symptom improvement. However, due to the lack of sufficient data in most publications, we emphasize the need for a multicentric registry to get further insights into this infrequent disease pattern.
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