Invited Commentary

Abstract

The authors [1Vistarini N. Chen C. Mazine A. et al.Pericardiectomy for constrictive pericarditis: 20 years of experience at the Montreal Heart Institute.Ann Thorac Surg. 2015; 100: 107-113Abstract Full Text Full Text PDF PubMed Scopus (49) Google Scholar] are to be congratulated on a significant series of patients having pericardiectomy for constrictive pericarditis in a single center, and for providing a thorough review of other series on the subject. In preparing this comment, my own search for manuscripts on the subject found little not referenced here. Constrictive pericarditis is an uncommon disease with few reports of large series and poor understanding of the factors contributing to morbidity and mortality. Even high-volume centers have provided few reports of series in this range, and this manuscript contributes significantly to our understanding of the problem. Constriction of the pericardium is a highly morbid disease leading to heart failure and death. While other forms of pericarditis may be best treated with anti-inflammatory strategies, surgical pericardiectomy is most effective for constriction and best when complete pericardiectomy is accomplished. The mortality of this procedure is high, with in-hospital rates of 5% to 12%. Those patients who survive the perioperative period have marked improvement in symptoms and good long-term survival. Understandably, the daunting risk of pericardiectomy deters many surgeons from accepting care of these patients, but the natural history is dismal in terms of both quality of life and survival. An understanding of factors impacting outcome is important to deciding when to operate, when to refer to a higher volume center, and how to counsel patients with this disease. Clearly patients with constriction requiring concomitant procedures, those with radiation-induce pericarditis, and those with long-standing symptoms fare worst. This series confirms that preoperative hepatomegaly or hepatic dysfunction, diabetes, and renal failure are predictors of early mortality. These are factors common to poor outcome for any heart surgery. For surgical survivors, quality of life is much improved. Late survival appears to be related to overall comorbidities rather than a history of constrictive pericarditis per se. Patients with constrictive pericarditis should be considered for pericardiectomy early in the process. The risk factors defined here, and in the few other series reported, should be considered and carefully explained to patients that they may best participate in the difficult decision regarding operation for this disease. Pericardiectomy for Constrictive Pericarditis: 20 Years of Experience at the Montreal Heart InstituteThe Annals of Thoracic SurgeryVol. 100Issue 1PreviewThe aim of this study was to evaluate our single-center experience with pericardiectomy for constrictive pericarditis. The main objectives of our analysis were long-term survival, clinical outcome, and identification of risk factors. Full-Text PDF