title: Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis.
abstract: OBJECTIVE
  Constrictive pericarditis has multiple etiologies and can lead to disabling symptoms and severe heart failure with poor quality of life. Surgical pericardiectomy is the cornerstone of management. All patients undergoing pericardiectomy at our institution were reviewed with the goal of analyzing preoperative and intraoperative factors that may be associated with long-term outcomes.
  
  
  METHODS
  A retrospective review of our cardiac surgery database identified all patients who underwent pericardiectomy for constrictive pericarditis between 1997 and 2012. Demographic, comorbidity, operative, and outcome data were analyzed.
  
  
  RESULTS
  Thirty-six patients underwent pericardiectomy for constrictive pericarditis over 15 years. Etiologies included idiopathic (n = 20, 55.6%), postoperative (n = 11, 30.5%), postradiation (n = 3, 8.3%), and tuberculosis (n = 2, 5.6%). Total pericardiectomy was performed in 35 patients. The average preoperative cardiac index was 2.6 L/min/m(2) with a significant increase to 3.1 L/min/m(2) noted in the immediate postoperative period (p = 0.03). There were no perioperative mortalities. The 1-year, 5-year, 10-year, and 15-year survival rates were 97.2%, 94.6%, 86.5%, and 78.3%, respectively. On multivariate analysis, preoperative heart failure (hazard ratio 2.2, p = 0.06), elevated preoperative total bilirubin (>2.7 mg/dL, hazard ratio 6.8, p = 0.02), and elevated creatinine (>1.4 mg/dL, hazard ratio 3.1, p = 0.05) were risk factors for increased long-term mortality. Kaplan-Meier survival analysis showed a significant decrease in overall survival associated with postradiation etiology (p = 0.05).
  
  
  CONCLUSIONS
  Pericardiectomy can be performed with low mortality and immediate improvement in hemodynamics. Those patients with compromised cardiac output, abnormal hepatic or renal function, or with previous radiation therapy have reduced long-term survival.
authors.affiliation: Department of Cardiothoracic Surgery, Weill Cornell Medical College, New York, New York.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Avgerinos
authors.forename: Yuri
authors.initials: Y
authors.lastname: Rabitnokov
authors.forename: Berhane
authors.initials: B
authors.lastname: Worku
authors.forename: Siyamek
authors.initials: S
authors.lastname: Neragi-Miandoab
authors.forename: Leonard N
authors.initials: LN
authors.lastname: Girardi
mesh_terms: D000368:Aged; D005260:Female; D006439:Hemodynamics; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy / Q000379:methods*; D010494:Pericarditis, Constrictive / Q000209:etiology / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D010640:Phenothiazines; D011878:Radiotherapy / Q000009:adverse effects; D012189:Retrospective Studies; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D016896:Treatment Outcome
chemical_list: D010640:Phenothiazines; C084584:periciazine