title: Pericardiectomy vs medical management in patients with relapsing pericarditis.
abstract: OBJECTIVE
  To determine whether surgical pericardiectomy is a safe and effective alternative to medical management for chronic relapsing pericarditis.
  
  
  METHODS
  Retrospective review of 184 patients presenting to the Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with persistent relapsing pericarditis identified 58 patients who had a pericardiectomy after failed medical management and 126 patients who continued with medical treatment only. The primary outcome variables were in-hospital postoperative mortality or major morbidity, all-cause death, time to relapse, and medication use.
  
  
  RESULTS
  Mean ± SD follow-up was 5.5 ± 3.5 years in the surgical group and 5.4 ± 4.4 years in the medical treatment group. At baseline, patients in the surgical group had higher mean relapses (6.9 vs 5.5; P=.01), were more likely to be taking colchicine (43.1% [n=25] vs 18.3% [n=23]; P=.002) and corticosteroids (70.7% [n=41] vs 42.1% [n=53]; P<.001), and were more likely to have undergone a prior pericardiotomy (27.6% [n=16] vs 11.1% [n=14]; P=.003) than the medical treatment group. Perioperative mortality (0%) and major morbidity (3%; n=2) were minimal. Kaplan-Meier analysis revealed no differences in all-cause death at follow-up (P=.26); however, the surgical group had a markedly decreased relapse rate compared with the medical treatment group (P=.009). Medication use was notably reduced after pericardiectomy.
  
  
  CONCLUSIONS
  In patients with chronic relapsing pericarditis in whom medical management has failed, surgical pericardiectomy is a safe and effective method of relieving symptoms.
authors.affiliation: Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN 55905, USA.
authors.forename: Masud H
authors.initials: MH
authors.lastname: Khandaker
authors.forename: Hartzell V
authors.initials: HV
authors.lastname: Schaff
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Greason
authors.forename: Nandan S
authors.initials: NS
authors.lastname: Anavekar
authors.forename: Raul E
authors.initials: RE
authors.lastname: Espinosa
authors.forename: Sharonne N
authors.initials: SN
authors.lastname: Hayes
authors.forename: Rick A
authors.initials: RA
authors.lastname: Nishimura
authors.forename: Jae K
authors.initials: JK
authors.lastname: Oh
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D008910:Minnesota; D010492:Pericardiectomy / Q000706:statistics & numerical data*; D010494:Pericarditis, Constrictive / Q000453:epidemiology* / Q000601:surgery*; D010495:Pericarditis, Tuberculous / Q000453:epidemiology* / Q000601:surgery*; D012189:Retrospective Studies; D055502:Secondary Prevention; D012720:Severity of Illness Index; D016019:Survival Analysis; D013997:Time Factors; D016896:Treatment Outcome