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CLINICAL RESEARCH: GENERAL CARDIOLOGY

Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy

Stefan C. Bertog, MD^*, Senthil K. Thambidorai, MD^*, Kapil Parakh, MD^*, Paul Schoenhagen, MD^*, Volkan Ozduran, MD^*, Penny L. Houghtaling, MS, Bruce W. Lytle, MD, FACC, Eugene H. Blackstone, MD, FACC, Michael S. Lauer, MD, FACC^* and Allan L. Klein, MD, FACC^*,*

^* Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Biostatistics and Epidemiology, The Cleveland Clinic Foundation, Cleveland, Ohio, USA
Department of Thoracic and Cardiovascular Surgery, The Cleveland Clinic Foundation, Cleveland, Ohio, USA

Manuscript received July 21, 2003; revised manuscript received October 28, 2003, accepted November 13, 2003.

^* Reprint requests and correspondence: Dr. Allan L. Klein, Department of Cardiovascular Medicine, The Cleveland Clinic Foundation, 9500 Euclid Avenue, Desk F-15, Cleveland, Ohio 44195, USA.
kleina{at}ccf.org

OBJECTIVES: We sought to determine the association of etiology of constrictive pericarditis (CP), pericardial calcification (CA), and other clinical variables with long-term survival after pericardiectomy.

BACKGROUND: Constrictive pericarditis is the result of a spectrum of primary cardiac and noncardiac conditions. Few data exist on the cause-specific survival after pericardiectomy. The impact of CA on survival is unclear.

METHODS: A total of 163 patients who underwent pericardiectomy for CP over a 24-year period at a single surgical center were studied. Constrictive pericarditis was confirmed by the surgical report. Vital status was obtained from the Social Security Death Index.

RESULTS: Etiology of CP was idiopathic in 75 patients (46%), prior cardiac surgery in 60 patients (37%), radiation treatment in 15 patients (9%), and miscellaneous in 13 patients (8%). Median follow-up among survivors was 6.9 years (range 0.8 to 24.5 years), during which time there were 61 deaths. Perioperative mortality was 6%. Idiopathic CP had the best prognosis (7-year Kaplan-Meier survival: 88%, 95% confidence interval [CI] 76% to 94%) followed by postsurgical (66%, 95% CI 52% to 78%) and postradiation CP (27%, 95% CI 9% to 58%). In bootstrap-validated proportional hazards analyses, predictors of poor overall survival were prior radiation, worse renal function, higher pulmonary artery systolic pressure (PAP), abnormal left ventricular (LV) systolic function, lower serum sodium level, and older age. Pericardial calcification had no impact on survival.

CONCLUSIONS: Long-term survival after pericardiectomy for CP is related to underlying etiology, LV systolic function, renal function, serum sodium, and PAP. The relatively good survival with idiopathic CP emphasizes the safety of pericardiectomy in this subgroup.

Abbreviations and Acronyms   CA = pericardial calcification   CAD = coronary artery disease   CI = confidence interval   CP = constrictive pericarditis   LV = left ventricular   PAP = pulmonary artery systolic pressure

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