Long-Term Clinical Outcomes and Prognostic Factors After Pericardiectomy for Constrictive Pericarditis in a Japanese Population

Abstract

Background: Constrictive pericarditis (CP) is characterized by impaired diastolic cardiac function leading to heart failure. Pericardiectomy is considered effective treatment for CP, but data on long-term clinical outcomes after pericardiectomy are limited. Methods and Results:We retrospectively investigated 45 consecutive patients (mean age, 59±14 years) who underwent pericardiectomy for CP. Preoperative clinical factors, parameters of cardiac catheterization, and cardiac events were examined. Cardiac events were defined as hospitalization owing to heart failure or cardiac death. Median follow-up was 5.7 years. CP etiology was idiopathic in 16 patients, post-cardiac surgery (CS) in 21, tuberculosis-related in 4, non-tuberculosis infection-related in 2, infarctionrelated in 1, and post-radiation in 1. The 5-year event-free survival was 65%. Patients with idiopathic CP and tuberculosis-related CP had favorable outcomes compared with post-CS CP (5-year event-free survival: idiopathic, 80%; tuberculosis, 100%; post-CS, 52%). Higher age (hazard ratio: 2.51), preoperative atrial fibrillation (3.25), advanced New York Heart Association class (3.92), and increased pulmonary artery pressure (1.06) were predictors of cardiac events. Patients with postoperative right-atrial pressure ≥9 mmHg had lower event-free survival than those with right-atrial pressure <9 mmHg (39% vs. 75% at 5 years, P=0.013).Conclusions: Long-term clinical outcomes after pericardiectomy among a Japanese population were related to the underlying etiology and the patient's preoperative clinical condition. Postoperative cardiac catheterization may be helpful in the prediction of prognosis after pericardiectomy.

Fifteen-year experience with pericardiectomy at a tertiary referral center

“…Our short- and long- term results are similar to those presented by other investigators [ 1 , 8 , 21 ]. However, some published reports indicated a significantly higher perioperative mortality; this may be due to differences in baseline patient characteristics as such studies often have a higher proportion of subjects classified as preoperative NYHA Class IV [ 2 , 5 – 8 , 11 , 14 , 24 ]. We find that there are a number of risk factors that affect survival after pericardiectomy, with the most significant being the presence of prior cardiac intervention, baseline chronic kidney disease with dialysis, and prior radiation exposure.…”

Chronic Constrictive Pericarditis (CCP) in Africa: Epidemiology, Etiology, Diagnosis, and Surgical Treatment

“…In a 24-year experience on pericardiectomy in patients with constrictive pericarditis, based on Kaplan-Meier survival curves demonstration, Szaboa et al [36] have confirmed poor prognosis of post-irradiation constrictive pericardiectomy and shown better and comparable long-term survival after in other etiologies as idiopathic tuberculosis myocardial infarction, and uremia; the author noted no survival after 5 years with post-radiation constrictive pericarditis; it is widely accepted radiation etiology is a negative factor affecting long-term survival results as well indicated by Nishimura in Japanese population [37] and Avgerinos et al [38]. On his study related to 46 patients with a mean age of 59 years and various classic etiologies, Nishumuna et al [37] have described the very high severity of radiation etiology with death within only 1 year after pericardiectomy confirming overall literature results.…”

Predictors of postoperative complication and prolonged intensive care unit stay after complete pericardiectomy in tuberculous constrictive pericarditis

“…Hypoalbuminemia was the major postoperative complication possibly because of the negative nitrogen balance after surgery. The incidence of low cardiac output was also high enough to warrant attention, because it was proven to be the major contributor to in-hospital death in other studies [3,22,23] . In our study, postoperative complication was seemed to be associated with symptom duration, preoperative NYHA functional class, pulse rate, preoperative CVP, pleural effusion and serum sodium, while multivariate analysis eventually proved that poor preoperative NYHA functional class and high preoperative CVP were independent risk factors of postoperative complication, which might provide a valuable reference for preoperative preparation and risk evaluation.…”