Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques.
BACKGROUND
This study was designed to compare the outcomes after total versus partial pericardiectomy clinically, echocardiographically, and hemodynamically.


METHODS
Three hundred ninety-five patients undergoing pericardiectomy for constrictive pericarditis between January 1985 and December 2004 were studied. Age was 10 months to 71 years (mean, 25.1 +/- 13.4 years). Three hundred thirty-eight patients (85.6%) underwent total pericardiectomy (group I), and 57 patients (14.4%) underwent partial pericardiectomy (group II).


RESULTS
Operative and late mortality rates were 7.6% and 4.9%, respectively. Preoperative high right atrial pressure, hyperbilirubinemia, renal dysfunction, atrial fibrillation, pericardial calcification, thoracotomy approach, and partial pericardiectomy were significant risk factors for death. The risk of death was 4.5 times higher (95% confidence interval: 2.05 to 9.75) in patients undergoing partial pericardiectomy. At a mean follow-up of 17.9 +/- 0.3 years (95% confidence interval: 17.3 to 18.6), actuarial survival was 83.8% +/- 0.04% in group I and 73.9% +/- 0.06% in group II (p = 0.004). At their last follow-up, 96.3% survivors of group I and 79.1% survivors of group II were in New York Heart Association class I/II (p < 0.001).


CONCLUSIONS
Total pericardiectomy is associated with lower perioperative and late mortality, and confers significant long-term advantage by providing superior hemodynamics that appear to be independent of the etiology of constrictive pericarditis.
Chowdhury
Ujjwal K
UK
Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. ujjwalchow@rediffmail.com
Subramaniam
Ganapathy K
GK
Kumar
A Sampath
AS
Airan
Balram
B
Singh
Rajvir
R
Talwar
Sachin
S
Seth
Sandeep
S
Mishra
Pankaj K
PK
Pradeep
Kizakke K
KK
Sathia
Siddhartha
S
Venugopal
Panangipalli
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D002648:Child; D002675:Child, Preschool; D004452:Echocardiography; D005260:Female; D006439:Hemodynamics; D006801:Humans; D007223:Infant; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy / Q000379:methods* / Q000401:mortality; D010494:Pericarditis, Constrictive / Q000401:mortality / Q000601:surgery*; D010495:Pericarditis, Tuberculous / Q000401:mortality / Q000601:surgery*; D011183:Postoperative Complications; D012189:Retrospective Studies; D013249:Sternum / Q000601:surgery; D016019:Survival Analysis; D013908:Thoracotomy; D016896:Treatment Outcome