Completion pericardiectomy for recurrent constrictive pericarditis: Importance of timing of recurrence on late clinical outcome of operation

Yang Hyun Cho, Hartzell V Schaff, Joseph A. Dearani, Richard C. Daly, Soon J. Park, Zhuo Li, Jae Kuen Oh

Research output: Contribution to journalArticle

36 Citations (Scopus)

Abstract

Background: Recurrent right-side heart failure after operation for constrictive pericarditis (CP) may be caused by incomplete pericardiectomy, recurrent constriction due to exuberant scar tissue, or diastolic dysfunction. Because the risks and benefits of reoperation are not well defined, we reviewed the outcome of completion pericardiectomy. Methods: From 1993 to December 2010, 41 patients underwent redo pericardiectomy. Thirty-eight patients had the initial operation elsewhere, and 3 had first pericardiectomy at our clinic. All patients had the diagnosis of CP at initial operation. We divided patients into two groups according to the interval between the first and second pericardiectomies: group A, 1 year or less, n = 20; group B, more than 1 year, n = 21. Results: The mean age was 57.6 ± 12.7 years, and there were 34 males (83%). Twenty-six patients (63%) were in New York Heart Association class II, 10 (24%) were in class III, and 5 (12%) were in class IV. Etiologies were idiopathic in 20 (49%), prior cardiac surgery in 13 (32%), radiation in 6 (15%), and trauma in 2 (5%). There was no significant difference in patient characteristics between group A and group B. The 30-day and in-hospital mortalities were 7% (n = 3) and 12% (n = 5), respectively. Overall 5-year survival was 49%, and was significantly better in group A than group B (73% versus 29%, p = 0.032). In multivariate analysis, New York Heart Association class III or IV and the interval between operations longer than 1 year were significant risk factors for death (p = 0.010 and p = 0.027, respectively). Conclusions: The significant early mortality of repeat pericardiectomy emphasizes the importance of complete pericardial resection at first operation and accurate diagnosis of recurrent constriction. The poor clinical outcome of late (more than 1 year) reoperation suggests that many of these patients may have unrecognized diastolic dysfunction or recurrent mediastinal scarring as the cause of right-side heart failure rather than incomplete initial pericardiectomy.

Original languageEnglish (US)
Pages (from-to)1236-1240
Number of pages5
JournalAnnals of Thoracic Surgery
Volume93
Issue number4
DOIs
StatePublished - Apr 2012

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Pericardiectomy
Constrictive Pericarditis
Recurrence
Reoperation
Constriction
Cicatrix
Heart Failure
Hospital Mortality
Thoracic Surgery
Multivariate Analysis
Radiation
Survival
Mortality
Wounds and Injuries

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery
  • Pulmonary and Respiratory Medicine

Cite this

Completion pericardiectomy for recurrent constrictive pericarditis : Importance of timing of recurrence on late clinical outcome of operation. / Cho, Yang Hyun; Schaff, Hartzell V; Dearani, Joseph A.; Daly, Richard C.; Park, Soon J.; Li, Zhuo; Oh, Jae Kuen.

In: Annals of Thoracic Surgery, Vol. 93, No. 4, 04.2012, p. 1236-1240.

Research output: Contribution to journalArticle

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abstract = "Background: Recurrent right-side heart failure after operation for constrictive pericarditis (CP) may be caused by incomplete pericardiectomy, recurrent constriction due to exuberant scar tissue, or diastolic dysfunction. Because the risks and benefits of reoperation are not well defined, we reviewed the outcome of completion pericardiectomy. Methods: From 1993 to December 2010, 41 patients underwent redo pericardiectomy. Thirty-eight patients had the initial operation elsewhere, and 3 had first pericardiectomy at our clinic. All patients had the diagnosis of CP at initial operation. We divided patients into two groups according to the interval between the first and second pericardiectomies: group A, 1 year or less, n = 20; group B, more than 1 year, n = 21. Results: The mean age was 57.6 ± 12.7 years, and there were 34 males (83{\%}). Twenty-six patients (63{\%}) were in New York Heart Association class II, 10 (24{\%}) were in class III, and 5 (12{\%}) were in class IV. Etiologies were idiopathic in 20 (49{\%}), prior cardiac surgery in 13 (32{\%}), radiation in 6 (15{\%}), and trauma in 2 (5{\%}). There was no significant difference in patient characteristics between group A and group B. The 30-day and in-hospital mortalities were 7{\%} (n = 3) and 12{\%} (n = 5), respectively. Overall 5-year survival was 49{\%}, and was significantly better in group A than group B (73{\%} versus 29{\%}, p = 0.032). In multivariate analysis, New York Heart Association class III or IV and the interval between operations longer than 1 year were significant risk factors for death (p = 0.010 and p = 0.027, respectively). Conclusions: The significant early mortality of repeat pericardiectomy emphasizes the importance of complete pericardial resection at first operation and accurate diagnosis of recurrent constriction. The poor clinical outcome of late (more than 1 year) reoperation suggests that many of these patients may have unrecognized diastolic dysfunction or recurrent mediastinal scarring as the cause of right-side heart failure rather than incomplete initial pericardiectomy.",
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T1 - Completion pericardiectomy for recurrent constrictive pericarditis

T2 - Importance of timing of recurrence on late clinical outcome of operation

AU - Cho, Yang Hyun

AU - Schaff, Hartzell V

AU - Dearani, Joseph A.

AU - Daly, Richard C.

AU - Park, Soon J.

AU - Li, Zhuo

AU - Oh, Jae Kuen

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N2 - Background: Recurrent right-side heart failure after operation for constrictive pericarditis (CP) may be caused by incomplete pericardiectomy, recurrent constriction due to exuberant scar tissue, or diastolic dysfunction. Because the risks and benefits of reoperation are not well defined, we reviewed the outcome of completion pericardiectomy. Methods: From 1993 to December 2010, 41 patients underwent redo pericardiectomy. Thirty-eight patients had the initial operation elsewhere, and 3 had first pericardiectomy at our clinic. All patients had the diagnosis of CP at initial operation. We divided patients into two groups according to the interval between the first and second pericardiectomies: group A, 1 year or less, n = 20; group B, more than 1 year, n = 21. Results: The mean age was 57.6 ± 12.7 years, and there were 34 males (83%). Twenty-six patients (63%) were in New York Heart Association class II, 10 (24%) were in class III, and 5 (12%) were in class IV. Etiologies were idiopathic in 20 (49%), prior cardiac surgery in 13 (32%), radiation in 6 (15%), and trauma in 2 (5%). There was no significant difference in patient characteristics between group A and group B. The 30-day and in-hospital mortalities were 7% (n = 3) and 12% (n = 5), respectively. Overall 5-year survival was 49%, and was significantly better in group A than group B (73% versus 29%, p = 0.032). In multivariate analysis, New York Heart Association class III or IV and the interval between operations longer than 1 year were significant risk factors for death (p = 0.010 and p = 0.027, respectively). Conclusions: The significant early mortality of repeat pericardiectomy emphasizes the importance of complete pericardial resection at first operation and accurate diagnosis of recurrent constriction. The poor clinical outcome of late (more than 1 year) reoperation suggests that many of these patients may have unrecognized diastolic dysfunction or recurrent mediastinal scarring as the cause of right-side heart failure rather than incomplete initial pericardiectomy.

AB - Background: Recurrent right-side heart failure after operation for constrictive pericarditis (CP) may be caused by incomplete pericardiectomy, recurrent constriction due to exuberant scar tissue, or diastolic dysfunction. Because the risks and benefits of reoperation are not well defined, we reviewed the outcome of completion pericardiectomy. Methods: From 1993 to December 2010, 41 patients underwent redo pericardiectomy. Thirty-eight patients had the initial operation elsewhere, and 3 had first pericardiectomy at our clinic. All patients had the diagnosis of CP at initial operation. We divided patients into two groups according to the interval between the first and second pericardiectomies: group A, 1 year or less, n = 20; group B, more than 1 year, n = 21. Results: The mean age was 57.6 ± 12.7 years, and there were 34 males (83%). Twenty-six patients (63%) were in New York Heart Association class II, 10 (24%) were in class III, and 5 (12%) were in class IV. Etiologies were idiopathic in 20 (49%), prior cardiac surgery in 13 (32%), radiation in 6 (15%), and trauma in 2 (5%). There was no significant difference in patient characteristics between group A and group B. The 30-day and in-hospital mortalities were 7% (n = 3) and 12% (n = 5), respectively. Overall 5-year survival was 49%, and was significantly better in group A than group B (73% versus 29%, p = 0.032). In multivariate analysis, New York Heart Association class III or IV and the interval between operations longer than 1 year were significant risk factors for death (p = 0.010 and p = 0.027, respectively). Conclusions: The significant early mortality of repeat pericardiectomy emphasizes the importance of complete pericardial resection at first operation and accurate diagnosis of recurrent constriction. The poor clinical outcome of late (more than 1 year) reoperation suggests that many of these patients may have unrecognized diastolic dysfunction or recurrent mediastinal scarring as the cause of right-side heart failure rather than incomplete initial pericardiectomy.

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