title: Child-Pugh score predicts survival after radical pericardiectomy for constrictive pericarditis.
abstract: BACKGROUND
  Constrictive pericarditis causes hepatic congestion, which results in congestive hepatopathy and finally leads to cardiac cirrhosis. However, in previous studies, risk stratification from the viewpoint of liver dysfunction was not performed in patients who underwent pericardiectomy for constrictive pericarditis.
  
  
  METHODS
  Sixty-four patients with constrictive pericarditis who were operated on with de novo radical pericardiectomy through a left anterolateral thoracotomy in our institute were entered into the study. Patients with a Child-Pugh score less than 7 (class A) were assigned to group CP-A (n = 45) and those with a score of 7 or higher (class B or C) were assigned to group CP-BC (n = 19). Actuarial survival of patients after operation was studied in each group, and prognostic factors were analyzed with Cox regression analysis.
  
  
  RESULTS
  Survival after radical pericardiectomy in group CP-BC (Child-Pugh score ≥ 7) was significantly worse than in group CP-A (37.9% versus 80.8% for 5-year survival; p = 0.0001, log-rank test). After multivariate Cox analysis, a Child-Pugh score of 7 or more (hazard ratio [HR] 4.316; p = 0.0028), mediastinal irradiation (HR, 23.872; p < 0.0001), age (HR, 1.064; p = 0.0042), and end-stage renal disease (HR, 4.670; p = 0.029) were identified as independent prognostic factors for mortality after radical pericardiectomy.
  
  
  CONCLUSIONS
  It is meaningful to apply the Child-Pugh scoring system for the prediction of mortality after radical pericardiectomy in patients with constrictive pericarditis.
authors.affiliation: Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum Berlin, Berlin, Germany. Electronic address: komoda@dhzb.de.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Komoda
authors.forename: Alexander
authors.initials: A
authors.lastname: Frumkin
authors.forename: Christoph
authors.initials: C
authors.lastname: Knosalla
authors.forename: Roland
authors.initials: R
authors.lastname: Hetzer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy; D010494:Pericarditis, Constrictive / Q000401:mortality* / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D055815:Young Adult
keywords: 32