Constrictive pericarditis in the modern era: Evolving clinical spectrum and impact on outcome after pericardiectomy

Lieng H. Ling, Jae K. Oh, Hartzell V. Schaff, Gordon K. Danielson, Douglas W. Mahoney, James B. Seward, A. Jamil Tajik

Research output: Contribution to journalArticle

384 Scopus citations

Abstract

Background - The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to determine the impact of these changes on the outcome of pericardiectomy. Methods and Results - The contemporary spectrum of CP in 135 patients (76% male) evaluated at the Mayo Clinic from 1985 to 1995 was compared with that of a historic cohort. Notable trends were an increasing frequency of CP due to cardiac surgery and mediastinal radiation and presentation in older patients (median age, 61 versus 45 years). Perioperative mortality decreased (6% versus 14%, P=0.011), but late survival was inferior to that of an age- and sex-matched US population (57±8% at 10 years). The long-term outcome was predicted independently by 3 variables in stepwise logistic regression analyses: (1) age, (2) NYHA class, and most powerfully, (3) a postradiation cause. Of 90 late survivors in whom functional class could be determined, functional status had improved markedly (2.6±0.7 at baseline versus 1.5±0.8 at latest follow-up [P<0.0001]), with 83% being free of clinical symptoms. Conclusions - The evolving profile of CP, with increasingly older patients and those with radiation-induced disease in the past decade, significantly affects postoperative prognosis. Long-term results of pericardiectomy are disappointing for some patient groups, especially those with radiation- induced CP. By contrast, surgery alleviates or improves symptoms in the majority of late survivors.

Original languageEnglish (US)
Pages (from-to)1380-1386
Number of pages7
JournalCirculation
Volume100
Issue number13
DOIs
StatePublished - Sep 28 1999

Keywords

  • Pericarditis
  • Prognosis
  • Surgery

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

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