Objectives. Chronic constrictive pericarditis is an uncommon disease, which diagnosis and treatment are still difficult. Here we present our recent experience with the surgical treatment of chronic constrictive pericarditis. Methods. Between January 2000 and December 2009, we have operated on 70 patients. Mean age at the time of operation was 54 ± 17 years (range 15-79 years) and there was a prevalence of male sex (65.7%). The etiology was as follows: undetermined (52.8%), post radiation therapy (15.7%), post cardiac surgery (14.3%), tuberculous (14.3%), viral (1.4%) and autoimmune (1.5%). Subtotal pericardiectomy, limited by the phrenic nerves, was always performed via median sternotomy. Redo operation was performed in 13 patients (18.5%) and combined surgery in 11 patients (15.7%; valvular surgery: n=7, coronary artery bypass grafting surgery: n=4). Results. Elective cardiopulmonary bypass was used in 10 patients. In-hospital mortality was 11% (n = 8). At univariate analysis the use of cardiopulmonary bypass (p <0.001) and the presence of other cardiac surgery procedures (p <0.001) were predictors of in-hospital mortality. One-year and 5-year survival was 95% and 79%, respectively. Conclusion. The etiology of chronic constrictive pericarditis remains unknown in about half the cases. Pericardiectomy is still the surgical treatment of choice. Operative mortality is low but it increases significantly when associated to other cardiac surgery procedures.
Surgical treatment of chronic constrictive pericarditis
POZZI, Matteo;
2011-01-01
Abstract
Objectives. Chronic constrictive pericarditis is an uncommon disease, which diagnosis and treatment are still difficult. Here we present our recent experience with the surgical treatment of chronic constrictive pericarditis. Methods. Between January 2000 and December 2009, we have operated on 70 patients. Mean age at the time of operation was 54 ± 17 years (range 15-79 years) and there was a prevalence of male sex (65.7%). The etiology was as follows: undetermined (52.8%), post radiation therapy (15.7%), post cardiac surgery (14.3%), tuberculous (14.3%), viral (1.4%) and autoimmune (1.5%). Subtotal pericardiectomy, limited by the phrenic nerves, was always performed via median sternotomy. Redo operation was performed in 13 patients (18.5%) and combined surgery in 11 patients (15.7%; valvular surgery: n=7, coronary artery bypass grafting surgery: n=4). Results. Elective cardiopulmonary bypass was used in 10 patients. In-hospital mortality was 11% (n = 8). At univariate analysis the use of cardiopulmonary bypass (p <0.001) and the presence of other cardiac surgery procedures (p <0.001) were predictors of in-hospital mortality. One-year and 5-year survival was 95% and 79%, respectively. Conclusion. The etiology of chronic constrictive pericarditis remains unknown in about half the cases. Pericardiectomy is still the surgical treatment of choice. Operative mortality is low but it increases significantly when associated to other cardiac surgery procedures.
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