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The Annals of Thoracic Surgery, Vol 52, 219-224, Copyright © 1991 by The Society of Thoracic Surgeons
PA DeValeria, WA Baumgartner, AS Casale, PS Greene, DE Cameron, TJ Gardner, VL Gott, L Watkins Jr and BA Reitz
A retrospective analysis of the records of 60 patients who underwent
pericardiectomy over a 10-year period (1980 to 1990) at The Johns Hopkins
Hospital was performed. Indications for operation were effusive disease in
24 patients and constriction in 36 patients. Six patients (10%) with
pericardial effusion had pain as the primary symptom necessitating
intervention. The operative approach for pericardiectomy was median
sternotomy in 52 patients (4 patients required cardiopulmonary bypass) and
left anterior thoracotomy in 8 patients. Nine patients (5 with constriction
and 4 with effusion) with a prior limited pericardial procedure required
formal pericardiectomy. The operative mortality rate for pericardial
effusion and constriction was 4.2% and 5.6%, respectively. Follow-up
(median follow-up, 56.9 +/- 38.2 months) was obtained on 56 patients
(93.3%). Actuarial survival at 1 year, 5 years, and 10 years for all
patients was 82.1% +/- 5.1%, 71.7% +/- 6.7%, and 59.8% +/- 12.2%,
respectively. A Cox proportional hazards regression analysis was performed
using 20 clinical variables. A history of malignancy, previous pericardial
procedure, and preoperative New York Heart Association class IV were found
to be predictors of poor survival. All patients who underwent operation
primarily for effusion with associated pain are alive and have improved
functional capacity without steroid use. We conclude that pericardiectomy
can be performed with low mortality and can result in good long-term
survival and improved functional capacity. Patients who are seen primarily
with pain refractory to steroid therapy can be relieved of symptoms with
operation.
ARTICLES
Current indications, risks, and outcome after pericardiectomy
Johns Hopkins Medical Institutions, Baltimore, Maryland.
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