Thirty year experience of constrictive pericarditis: one-hundred and forty cases with a long-term follow-up

Abstract

Objectives and methods: 1. To describe the clinical presentation, etiology, diagnostic tecniques, surgical findings and long-term follow-up of patients operated of Constrictive Pericarditis (CP). 2. To identify independent predictors of poor outcome after pericardiectomy. Retrospective analysis of all operated cases of CP: Clinical data, surgical findings and follow-up (FU) were recorded. Results: Between 1978 and 2012, 140 patients underwent pericardiectomy for CP (Male = 99 (71%), age=54 years-old, range (17-80y). Clinical presentation: Congestive heart failure (124p, 87%), chest pain (46p, 33%) or fever (33, 23.4%). Forty-nine patients (35%) were in an advanced NYHA class (III or IV) before surgery. The most frequent etiology of CP was idiopatic (71%). In patients with a specific cause of CP, tuberculosis (11%) was the most frequent diagnosis. Sixteen patients (11%) died perioperatively. Predictors of perioperative mortality were age (66±11 vs 53±16 years, p=0.002), NYHA status III or IV (31% vs 62%, p=0.014) and presence of pericardial effusion (27% vs 60%, p=0.01). Overall mortality during FU (12 years (range 0.1 to 34.5y)) was 39%. Long-term FU analysis (124 patients) showed that independent predictors of death were age at surgery (HR 1.05, 95% CI: 1.017-1.088), a previous episode of acute pericarditis (HR 2.93, 95% CI 1.26-6.81) and a preoperative NYHA status III or IV (HR 4.03, 95% CI 1.79-9.05). Etiology did not have an impact neither in perioperative survival nor in the long-term FU. View this table: Use of diagnostic procedures Conclusions: Idiopatic pericarditis is the most frequent cause of CP. Perioperative mortality is high. Factors associated with a poor perioperative outcome are age, advanced NYHA status and moderate or severe pericardial effusion. Long-term FU shows that independent predictors of poor outcome are age at surgery, advanced NYHA status and a previous episode of acute pericarditis.