Outcomes of Pericardiectomy for Constrictive Pericarditis following
Mediastinal Irradiation
Abstract
Background Pericardiectomy for post-radiation constrictive pericarditis
has been reported to generally have unfavorable outcomes. This study
sought to evaluate surgical outcomes in a large cohort of patients
undergoing pericardiectomy for radiation-associated pericardial
constriction. Methods A retrospective analysis of all patients
(≥18years) who underwent pericardiectomy for a diagnosis of constrictive
pericarditis with a prior history of mediastinal irradiation from June
2002 to June 2019 was conducted. There were 100 patients (mean age
57.2±10.1 years, 49% females) who met the inclusion criteria. Records
were reviewed to look at surgical approach, extent of resection, early
mortality and late survival. Results The overall operative mortality was
10.1% (n=10). The rate of operative mortality decreased over the study
period; however, the test of trend was not statistically significant
(P=0.062). Hodgkin’s disease was the most common malignancy (64%) for
which mediastinal radiation had been received. Only 27% patients had an
isolated pericardiectomy, and concomitant pericardiectomy and valve
surgery was performed in 46% patients. Radical resection was performed
in 50% patients, whereas 47% patients underwent a subtotal resection.
Prolonged ventilation (26%), atrial fibrillation (21%) and pleural
effusion (16%) were the most common post-operative complications. The
overall 1,5- and 10-years survival was 73.6%, 53.4% and 32.1%
respectively. Increasing age (HR 1.044, 95%CI 1.017-1.073) appeared to
have a significant negative effect on overall survival in the univariate
model. Conclusion Pericardiectomy performed for radiation associated
constrictive pericarditis has poor long-term outcomes. The early
mortality, though high (~10%), has been showing a
decreasing trend in the test of time.