Pericardiectomy vs medical management in patients with relapsing pericarditis

Masud H. Khandaker, Hartzell V Schaff, Kevin L. Greason, Nandan S. Anavekar, Raul Emilio Espinosa, Sharonne N. Hayes, Rick A. Nishimura, Jae Kuen Oh

Research output: Contribution to journalArticle

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Abstract

Objective: To determine whether surgical pericardiectomy is a safe and effective alternative to medical management for chronic relapsing pericarditis. Patients and Methods: Retrospective review of 184 patients presenting to the Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with persistent relapsing pericarditis identified 58 patients who had a pericardiectomy after failed medical management and 126 patients who continued with medical treatment only. The primary outcome variables were in-hospital postoperative mortality or major morbidity, all-cause death, time to relapse, and medication use. Results: Mean ± SD follow-up was 5.5±3.5 years in the surgical group and 5.4±4.4 years in the medical treatment group. At baseline, patients in the surgical group had higher mean relapses (6.9 vs 5.5; P=.01), were more likely to be taking colchicine (43.1% [n=25] vs 18.3% [n=23]; P=.002) and corticosteroids (70.7% [n=41] vs 42.1% [n=53]; P<.001), and were more likely to have undergone a prior pericardiotomy (27.6% [n=16] vs 11.1% [n=14]; P=.003) than the medical treatment group. Perioperative mortality (0%) and major morbidity (3%; n=2) were minimal. Kaplan-Meier analysis revealed no differences in all-cause death at follow-up (P=.26); however, the surgical group had a markedly decreased relapse rate compared with the medical treatment group (P=.009). Medication use was notably reduced after pericardiectomy. Conclusion: In patients with chronic relapsing pericarditis in whom medical management has failed, surgical pericardiectomy is a safe and effective method of relieving symptoms.

Original languageEnglish (US)
Pages (from-to)1062-1070
Number of pages9
JournalMayo Clinic Proceedings
Volume87
Issue number11
DOIs
StatePublished - 2012

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Pericardiectomy
Pericarditis
Recurrence
Cause of Death
Morbidity
Colchicine
Kaplan-Meier Estimate
Therapeutics
Hospital Mortality
Adrenal Cortex Hormones
Mortality

ASJC Scopus subject areas

  • Medicine(all)

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Pericardiectomy vs medical management in patients with relapsing pericarditis. / Khandaker, Masud H.; Schaff, Hartzell V; Greason, Kevin L.; Anavekar, Nandan S.; Espinosa, Raul Emilio; Hayes, Sharonne N.; Nishimura, Rick A.; Oh, Jae Kuen.

In: Mayo Clinic Proceedings, Vol. 87, No. 11, 2012, p. 1062-1070.

Research output: Contribution to journalArticle

Khandaker, Masud H. ; Schaff, Hartzell V ; Greason, Kevin L. ; Anavekar, Nandan S. ; Espinosa, Raul Emilio ; Hayes, Sharonne N. ; Nishimura, Rick A. ; Oh, Jae Kuen. / Pericardiectomy vs medical management in patients with relapsing pericarditis. In: Mayo Clinic Proceedings. 2012 ; Vol. 87, No. 11. pp. 1062-1070.
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abstract = "Objective: To determine whether surgical pericardiectomy is a safe and effective alternative to medical management for chronic relapsing pericarditis. Patients and Methods: Retrospective review of 184 patients presenting to the Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with persistent relapsing pericarditis identified 58 patients who had a pericardiectomy after failed medical management and 126 patients who continued with medical treatment only. The primary outcome variables were in-hospital postoperative mortality or major morbidity, all-cause death, time to relapse, and medication use. Results: Mean ± SD follow-up was 5.5±3.5 years in the surgical group and 5.4±4.4 years in the medical treatment group. At baseline, patients in the surgical group had higher mean relapses (6.9 vs 5.5; P=.01), were more likely to be taking colchicine (43.1{\%} [n=25] vs 18.3{\%} [n=23]; P=.002) and corticosteroids (70.7{\%} [n=41] vs 42.1{\%} [n=53]; P<.001), and were more likely to have undergone a prior pericardiotomy (27.6{\%} [n=16] vs 11.1{\%} [n=14]; P=.003) than the medical treatment group. Perioperative mortality (0{\%}) and major morbidity (3{\%}; n=2) were minimal. Kaplan-Meier analysis revealed no differences in all-cause death at follow-up (P=.26); however, the surgical group had a markedly decreased relapse rate compared with the medical treatment group (P=.009). Medication use was notably reduced after pericardiectomy. Conclusion: In patients with chronic relapsing pericarditis in whom medical management has failed, surgical pericardiectomy is a safe and effective method of relieving symptoms.",
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AU - Espinosa, Raul Emilio

AU - Hayes, Sharonne N.

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AB - Objective: To determine whether surgical pericardiectomy is a safe and effective alternative to medical management for chronic relapsing pericarditis. Patients and Methods: Retrospective review of 184 patients presenting to the Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with persistent relapsing pericarditis identified 58 patients who had a pericardiectomy after failed medical management and 126 patients who continued with medical treatment only. The primary outcome variables were in-hospital postoperative mortality or major morbidity, all-cause death, time to relapse, and medication use. Results: Mean ± SD follow-up was 5.5±3.5 years in the surgical group and 5.4±4.4 years in the medical treatment group. At baseline, patients in the surgical group had higher mean relapses (6.9 vs 5.5; P=.01), were more likely to be taking colchicine (43.1% [n=25] vs 18.3% [n=23]; P=.002) and corticosteroids (70.7% [n=41] vs 42.1% [n=53]; P<.001), and were more likely to have undergone a prior pericardiotomy (27.6% [n=16] vs 11.1% [n=14]; P=.003) than the medical treatment group. Perioperative mortality (0%) and major morbidity (3%; n=2) were minimal. Kaplan-Meier analysis revealed no differences in all-cause death at follow-up (P=.26); however, the surgical group had a markedly decreased relapse rate compared with the medical treatment group (P=.009). Medication use was notably reduced after pericardiectomy. Conclusion: In patients with chronic relapsing pericarditis in whom medical management has failed, surgical pericardiectomy is a safe and effective method of relieving symptoms.

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