HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): George J. Arnaoutakis Arman Kilic William A. Baumgartner John V. Conte Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by George, T. J. Articles by Conte, J. V. Search for Related Content PubMed PubMed Citation Articles by George, T. J. Articles by Conte, J. V. Related Collections Pericardium

---

Original Articles: Adult Cardiac

Contemporary Etiologies, Risk Factors, and Outcomes After Pericardiectomy

Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland

Accepted for publication March 29, 2012.

^_* Address correspondence to Dr Conte, Division of Cardiac Surgery, The Johns Hopkins Medical Institutions, 600 N Wolfe St, Blalock 618, Baltimore, MD 21287 (Email: jconte{at}jhmi.edu).

Presented at the Poster Session of the Forty-eighth Annual Meeting of The Society of Thoracic Surgeons, Fort Lauderdale, FL, Jan 28–Feb 1, 2012.

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.

This article has been cited by other articles:

				G. Szabo, B. Schmack, C. Bulut, P. Soos, A. Weymann, S. Stadtfeld, and M. Karck Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience Eur J Cardiothorac Surg, June 12, 2013; (2013) ezt138v1. [Abstract] [Full Text] [PDF]