Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation

Abstract

Background: Pericardiectomy for postradiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction.Methods: A retrospective analysis of all patients (≥18 years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2 ± 10.1 years, 49% females) who met the inclusion criteria.Records were reviewed to look at the surgical approach, the extent of resection, early mortality, and late survival.Results: The overall operative mortality was 10.1% (n = 10). The rate of operative mortality decreased over the study period; however, the test of the trend was not statistically significant (p = .062). Hodgkin's disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% of patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery were performed in 46% of patients. Radical resection was performed in 50% of patients, whereas 47% of patients underwent subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%), and pleural effusion (16%) were the most common postoperative complications. The overall 1, 5-, and 10-years survival was 73.6%, 53.4%, and 32.1%, respectively. Increasing age (hazard ratio, 1.044, 95% confidence interval 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model. Conclusion:Pericardiectomy performed for radiation-associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.

Totally Endoscopic Constrictive Pericarditis Treatment: A Case Series

“…1,4 Pericardiectomy performed for radiation-associated constrictive pericarditis presented an even higher operative mortality of 10.1%. 5 In our series of patients, we show that isolated pericardiectomy associated with or without tricuspid valve repair can be performed safely with low morbidity and no in-hospital mortality. The use of CPB during totally endoscopic treatment was mandatory to reduce the volume and pressure in the cardiac chambers to detach the pericardium, and in this preliminary series, it did not affect the early outcome.…”

Pyothorax and Constrictive Pericarditis after Chemoradiotherapy for Esophageal Cancer

“…However, assessing the characteristic hemodynamic features of constrictive pericarditis via general echocardiography may prove difficult and often cause delays in the diagnosis (7), as observed in the present case. In surgical cases, the prognosis of constrictive pericarditis due to radiotherapy is poor, with operative mortality and 10-year survival rates of 10% and 32%, respectively (8). Although the current case was diagnosed at an early stage, surgery for constrictive pericarditis would have been difficult because of the presence of pyothorax.…”

Constrictive Pericarditis: Surgical Management

“…In fact, mediastinal irradiation is considered an independent prognostic factor for mortality following surgical correction of constrictive pericarditis, with 5-year survival at a dismal 11.0% and an increased 10-year mortality rate [13]. One retrospective study reported an overall intraoperative mortality of 10.1% for patients with a history of mediastinal irradiation over a seventeen-year period, though it should be noted that the majority of those patients underwent concomitant procedures that may have attributed to their outcome [31]. While there have been numerous reports indicating poor outcomes for patients undergoing pericardiectomy following mediastinal radiation treatment, it cannot be overlooked that the increased mortality rates among these patients may be related to their original need for radiation therapy, rather than an interaction between pericardiectomy and irradiated tissue.…”