title: Validation of Waffle procedure for constrictive pericarditis with epicardial thickening.
abstract: OBJECTIVE
  Waffle procedure, a small grid-like incision of epicardium, is a surgical technique for constrictive pericarditis with epicardial thickening. Yet evidences to endorse this approach for improved outcomes are lacking. The aim of this study is to elucidate better surgical treatment strategy for constrictive pericarditis with epicardial thickening.
  
  
  METHODS
  Twenty-five patients (mean 64.1 years) who underwent pericardiectomy for constrictive pericarditis between January 1992 and July 2012 were included in this study and were classified into two groups according to the procedure they received; single total pericardiectomy (Group A, n = 17) and total pericardiectomy with the Waffle procedure (Group B, n = 8). Early and mid-term outcomes were analyzed for each group.
  
  
  RESULTS
  No major postoperative complications or all-cause deaths at 30 days were observed in each group. Upon discharge, postoperative echocardiography showed statistically significant increase of left ventricular end-diastolic volume (from 76.6 ± 30.3 to 91.0 ± 27.3 ml; p < 0.02) and systolic volume (from 44.4 ± 19.1 to 54.5 ± 17.3 ml; p < 0.05) in Group B than those in Group A. The 5-year cardiac event-free rate was similar between groups [83.6 ± 10.8 % for group A and 83.3 ± 15.2 % for group B (p = NS)] as well as the mean value of NYHA classification for each at the mid-term periods (1.5 for Group A and 1.3 for Group B).
  
  
  CONCLUSIONS
  Waffle procedure improved echocardiographic elements of diastolic function of patients with epicardial thickening more than did total pericardiectomy without additional compromises.
authors.affiliation: Department of Cardiovascular Surgery, Saitama Medical Center, Jichi Medical University, 1-847 Amanuma, Omiya-Ku, Saitama, 330-8503, Japan, manabu@omiya.jichi.ac.jp.
authors.forename: Manabu
authors.initials: M
authors.lastname: Shiraishi
authors.forename: Atsushi
authors.initials: A
authors.lastname: Yamaguchi
authors.forename: Kenichi
authors.initials: K
authors.lastname: Muramatsu
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Kimura
authors.forename: Koichi
authors.initials: K
authors.lastname: Yuri
authors.forename: Harunobu
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kouichi
authors.initials: K
authors.lastname: Adachi
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
mesh_terms: D000368:Aged; D016022:Case-Control Studies; D003971:Diastole; D004452:Echocardiography; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010492:Pericardiectomy / Q000379:methods*; D010494:Pericarditis, Constrictive / Q000000981:diagnostic imaging / Q000601:surgery*; D010496:Pericardium / Q000601:surgery*; D013318:Stroke Volume; D013599:Systole; D016896:Treatment Outcome