Early and late results of pericardiectomy for constrictive pericarditis

B. C. McCaughan, Hartzell V Schaff, J. M. Piehler, G. K. Danielson, T. A. Orszulak, F. J. Puga, J. R. Pluth, D. C. Connolly, D. C. McGoon

Research output: Contribution to journalArticle

147 Citations (Scopus)

Abstract

Records of 231 patients (171 males, 60 females; aged 10 months to 83 years [median 45 years]) who underwent operation for constrictive pericarditis at the Mayo Clinic from 1936 through 1982 were reviewed. All had had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, 69% were in New York Heart Association Class III or IV and 81% had peripheral edema or ascites. Pericardiectomy was performed through a left anterolateral thoracotomy (34%), a median sternotomy (27%), a U incision (Harrington) (21%), or a bilateral anterior thoracotomy (18%). Postoperatively, 28% of patients had evidence of low cardiac output; 70% of the 32 deaths within 30 days of operation were due to low cardiac output. Operative risk was significantly (p<0.001) related to preoperative disability (1% for Class I or II; 10% for class III; 46% for Class IV). Median postoperative follow-up was 9 years (longest was 43 years). Probability of survival for patients dismissed alive from the hospital was 84% at 5 years, 71% at 15 years, and 52% at 30 years. Long-term survival (excluding operative mortality) was not significantly influenced by the disability class preoperatively, the operative approach, or the development of low cardiac output in the immediate postoperative period. At the end of the follow-up interval, there were 141 patients in whom functional capacity could be assessed; 140 were in Class I or II. We conclude that a poor hemodynamic result after complete pericardiectomy relates to the preoperative degree of constriction and resultant cardiomyopathy. We recommend early pericardiectomy when pericardial constriction is diagnosed, and we continue to use a left anterolateral thoracotomy as the preferred approach for most patients.

Original languageEnglish (US)
Pages (from-to)340-350
Number of pages11
JournalJournal of Thoracic and Cardiovascular Surgery
Volume89
Issue number3
StatePublished - 1985

Fingerprint

Pericardiectomy
Constrictive Pericarditis
Low Cardiac Output
Thoracotomy
Constriction
Sternotomy
Survival
Cardiomyopathies
Ascites
Postoperative Period
Edema
Hemodynamics
Mortality

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Surgery

Cite this

McCaughan, B. C., Schaff, H. V., Piehler, J. M., Danielson, G. K., Orszulak, T. A., Puga, F. J., ... McGoon, D. C. (1985). Early and late results of pericardiectomy for constrictive pericarditis. Journal of Thoracic and Cardiovascular Surgery, 89(3), 340-350.

Early and late results of pericardiectomy for constrictive pericarditis. / McCaughan, B. C.; Schaff, Hartzell V; Piehler, J. M.; Danielson, G. K.; Orszulak, T. A.; Puga, F. J.; Pluth, J. R.; Connolly, D. C.; McGoon, D. C.

In: Journal of Thoracic and Cardiovascular Surgery, Vol. 89, No. 3, 1985, p. 340-350.

Research output: Contribution to journalArticle

McCaughan, BC, Schaff, HV, Piehler, JM, Danielson, GK, Orszulak, TA, Puga, FJ, Pluth, JR, Connolly, DC & McGoon, DC 1985, 'Early and late results of pericardiectomy for constrictive pericarditis', Journal of Thoracic and Cardiovascular Surgery, vol. 89, no. 3, pp. 340-350.
McCaughan BC, Schaff HV, Piehler JM, Danielson GK, Orszulak TA, Puga FJ et al. Early and late results of pericardiectomy for constrictive pericarditis. Journal of Thoracic and Cardiovascular Surgery. 1985;89(3):340-350.
McCaughan, B. C. ; Schaff, Hartzell V ; Piehler, J. M. ; Danielson, G. K. ; Orszulak, T. A. ; Puga, F. J. ; Pluth, J. R. ; Connolly, D. C. ; McGoon, D. C. / Early and late results of pericardiectomy for constrictive pericarditis. In: Journal of Thoracic and Cardiovascular Surgery. 1985 ; Vol. 89, No. 3. pp. 340-350.
@article{a7742f3af19e4515a9e6b80d16186690,
title = "Early and late results of pericardiectomy for constrictive pericarditis",
abstract = "Records of 231 patients (171 males, 60 females; aged 10 months to 83 years [median 45 years]) who underwent operation for constrictive pericarditis at the Mayo Clinic from 1936 through 1982 were reviewed. All had had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, 69{\%} were in New York Heart Association Class III or IV and 81{\%} had peripheral edema or ascites. Pericardiectomy was performed through a left anterolateral thoracotomy (34{\%}), a median sternotomy (27{\%}), a U incision (Harrington) (21{\%}), or a bilateral anterior thoracotomy (18{\%}). Postoperatively, 28{\%} of patients had evidence of low cardiac output; 70{\%} of the 32 deaths within 30 days of operation were due to low cardiac output. Operative risk was significantly (p<0.001) related to preoperative disability (1{\%} for Class I or II; 10{\%} for class III; 46{\%} for Class IV). Median postoperative follow-up was 9 years (longest was 43 years). Probability of survival for patients dismissed alive from the hospital was 84{\%} at 5 years, 71{\%} at 15 years, and 52{\%} at 30 years. Long-term survival (excluding operative mortality) was not significantly influenced by the disability class preoperatively, the operative approach, or the development of low cardiac output in the immediate postoperative period. At the end of the follow-up interval, there were 141 patients in whom functional capacity could be assessed; 140 were in Class I or II. We conclude that a poor hemodynamic result after complete pericardiectomy relates to the preoperative degree of constriction and resultant cardiomyopathy. We recommend early pericardiectomy when pericardial constriction is diagnosed, and we continue to use a left anterolateral thoracotomy as the preferred approach for most patients.",
author = "McCaughan, {B. C.} and Schaff, {Hartzell V} and Piehler, {J. M.} and Danielson, {G. K.} and Orszulak, {T. A.} and Puga, {F. J.} and Pluth, {J. R.} and Connolly, {D. C.} and McGoon, {D. C.}",
year = "1985",
language = "English (US)",
volume = "89",
pages = "340--350",
journal = "Journal of Thoracic and Cardiovascular Surgery",
issn = "0022-5223",
publisher = "Mosby Inc.",
number = "3",

}

TY - JOUR

T1 - Early and late results of pericardiectomy for constrictive pericarditis

AU - McCaughan, B. C.

AU - Schaff, Hartzell V

AU - Piehler, J. M.

AU - Danielson, G. K.

AU - Orszulak, T. A.

AU - Puga, F. J.

AU - Pluth, J. R.

AU - Connolly, D. C.

AU - McGoon, D. C.

PY - 1985

Y1 - 1985

N2 - Records of 231 patients (171 males, 60 females; aged 10 months to 83 years [median 45 years]) who underwent operation for constrictive pericarditis at the Mayo Clinic from 1936 through 1982 were reviewed. All had had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, 69% were in New York Heart Association Class III or IV and 81% had peripheral edema or ascites. Pericardiectomy was performed through a left anterolateral thoracotomy (34%), a median sternotomy (27%), a U incision (Harrington) (21%), or a bilateral anterior thoracotomy (18%). Postoperatively, 28% of patients had evidence of low cardiac output; 70% of the 32 deaths within 30 days of operation were due to low cardiac output. Operative risk was significantly (p<0.001) related to preoperative disability (1% for Class I or II; 10% for class III; 46% for Class IV). Median postoperative follow-up was 9 years (longest was 43 years). Probability of survival for patients dismissed alive from the hospital was 84% at 5 years, 71% at 15 years, and 52% at 30 years. Long-term survival (excluding operative mortality) was not significantly influenced by the disability class preoperatively, the operative approach, or the development of low cardiac output in the immediate postoperative period. At the end of the follow-up interval, there were 141 patients in whom functional capacity could be assessed; 140 were in Class I or II. We conclude that a poor hemodynamic result after complete pericardiectomy relates to the preoperative degree of constriction and resultant cardiomyopathy. We recommend early pericardiectomy when pericardial constriction is diagnosed, and we continue to use a left anterolateral thoracotomy as the preferred approach for most patients.

AB - Records of 231 patients (171 males, 60 females; aged 10 months to 83 years [median 45 years]) who underwent operation for constrictive pericarditis at the Mayo Clinic from 1936 through 1982 were reviewed. All had had hemodynamically significant pericardial constriction preoperatively, and pericardial disease was confirmed at operation. Preoperatively, 69% were in New York Heart Association Class III or IV and 81% had peripheral edema or ascites. Pericardiectomy was performed through a left anterolateral thoracotomy (34%), a median sternotomy (27%), a U incision (Harrington) (21%), or a bilateral anterior thoracotomy (18%). Postoperatively, 28% of patients had evidence of low cardiac output; 70% of the 32 deaths within 30 days of operation were due to low cardiac output. Operative risk was significantly (p<0.001) related to preoperative disability (1% for Class I or II; 10% for class III; 46% for Class IV). Median postoperative follow-up was 9 years (longest was 43 years). Probability of survival for patients dismissed alive from the hospital was 84% at 5 years, 71% at 15 years, and 52% at 30 years. Long-term survival (excluding operative mortality) was not significantly influenced by the disability class preoperatively, the operative approach, or the development of low cardiac output in the immediate postoperative period. At the end of the follow-up interval, there were 141 patients in whom functional capacity could be assessed; 140 were in Class I or II. We conclude that a poor hemodynamic result after complete pericardiectomy relates to the preoperative degree of constriction and resultant cardiomyopathy. We recommend early pericardiectomy when pericardial constriction is diagnosed, and we continue to use a left anterolateral thoracotomy as the preferred approach for most patients.

UR - http://www.scopus.com/inward/record.url?scp=0022408747&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0022408747&partnerID=8YFLogxK

M3 - Article

C2 - 3974269

AN - SCOPUS:0022408747

VL - 89

SP - 340

EP - 350

JO - Journal of Thoracic and Cardiovascular Surgery

JF - Journal of Thoracic and Cardiovascular Surgery

SN - 0022-5223

IS - 3

ER -