title: Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques.
abstract: 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.
authors.affiliation: Cardiothoracic Centre, All India Institute of Medical Sciences, New Delhi, India. ujjwalchow@rediffmail.com
authors.forename: Ujjwal K
authors.initials: UK
authors.lastname: Chowdhury
authors.forename: Ganapathy K
authors.initials: GK
authors.lastname: Subramaniam
authors.forename: A Sampath
authors.initials: AS
authors.lastname: Kumar
authors.forename: Balram
authors.initials: B
authors.lastname: Airan
authors.forename: Rajvir
authors.initials: R
authors.lastname: Singh
authors.forename: Sachin
authors.initials: S
authors.lastname: Talwar
authors.forename: Sandeep
authors.initials: S
authors.lastname: Seth
authors.forename: Pankaj K
authors.initials: PK
authors.lastname: Mishra
authors.forename: Kizakke K
authors.initials: KK
authors.lastname: Pradeep
authors.forename: Siddhartha
authors.initials: S
authors.lastname: Sathia
authors.forename: Panangipalli
authors.initials: P
authors.lastname: Venugopal
mesh_terms: 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