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OBJECTIVE: Echocardiographic findings prior to pericardiectomy of constrictive pericarditis are well documented. However, there were only few reports on sequential alteration of echocardiogram after pericardiectomy. The purpose of this study is to analyze alteration of echocardiographic findings after pericardiectomy and to uncover the long-term perioperative survival factors for constrictive pericarditis.
METHODS: A total of 90 consecutive patients who underwent pericardiectomy from 1995 to 2015 in Seoul Samsung Medical Center were analyzed retrospectively. Patients were categorized into the conventional group and the extended group according to the extent of removal of pericardium based on the relative position to the phrenic nerve. Echocardiographic findings were sorted into three groups: preoperative, immediate postoperative, and the most recent. The median follow-up period was 37.6 months.
RESULTS: The early mortality rate was 4.4% and the late mortality rate was 4.4% as well. The 10-year survival rates were 70.3 +/- 12.3% for the conventional group and 95.0+/-4.9% for the extended group which were calculated by the Kaplan-Meier method (P=0.021). When multivariate analysis were applied to analyze the long-term survival factors, the odd of survival was 24.9 times greater for the extended group (P=0.021), and the odd of survival was 17.8 times greater when cardiopulmonary bypass was used (P=0.008). When the predictive factors for Major Adverse Cardiocerebral Events (MACCE) were analyzed, patients who had atrial fibrillation prior to the surgery had 29.3 times greater chance of MACCE (P=0.015) and the patients with early morbidity had 13.6 times higher chance of MACCE (P=0.015). On echocardiographic findings of the immediate postoperative and the most recent examination for both groups, the medial mitral annulus velocity during diastole was significantly decreased and the ratio of the lateral mitral annulus velocity to the medial mitral annulus velocity during diastole was significantly reduced as well.
CONCLUSIONS: Although the postoperative echocardiography may show diminished clinical findings of constrictive physiology regardless of the extent of pericardiectomy, using CPB and removal of pericardium beyond the phrenic nerve posteriorly significantly increased the long-term survival rate. Atrial fibrillation prior to the surgery and early morbidity were the predictive factors for MACCE.