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The Journal of Thoracic and Cardiovascular Surgery, Vol 89, 340-350, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association
BC McCaughan, HV Schaff, JM Piehler, GK Danielson, TA Orszulak, FJ Puga, JR Pluth, DC Connolly and DC McGoon
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 less than 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.
ARTICLES
Early and late results of pericardiectomy for constrictive pericarditis
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