Our Summary

This study looked at the outcomes of a type of heart surgery called pericardiectomy, which is done to treat constrictive pericarditis - a condition where the sac around the heart becomes stiff and affects heart function. The researchers analyzed data from all the patients who underwent this surgery from 1936 to 2013.

They divided the patients into two groups: those who had surgery before 1990 (the historical group) and those who had surgery between 1990 and 2013 (the contemporary group). The study found that patients in the contemporary group were older, had more severe symptoms, and often had additional procedures compared to the historical group.

Interestingly, while in the past most cases of constrictive pericarditis had no known cause (idiopathic), nearly half of the cases in the contemporary group were due to specific causes like prior surgery or radiation. The good news is that the death rate within 30 days of surgery decreased from 13.5% in the historical period to 5.2% in the contemporary period.

However, the overall survival rate was similar in both groups when accounting for patient characteristics. Factors that increased the risk of death in the contemporary group were severe symptoms, radiation as the cause of the disease, prior heart surgery, and the need for a heart-lung machine during surgery.

In simple terms, the study found that the cause and severity of the disease, as well as the need for additional procedures, affect how well patients do after surgery for constrictive pericarditis, despite improvements in short-term survival.

FAQs

  1. What is pericardiectomy and why is it performed?
  2. How have the causes and outcomes of pericardiectomy changed over time according to this study?
  3. What factors were found to increase the risk of death in the contemporary group of patients who underwent pericardiectomy?

Doctor’s Tip

One helpful tip a doctor might give a patient about pericardiectomy is to closely follow post-operative care instructions, including taking medications as prescribed, attending follow-up appointments, and participating in cardiac rehabilitation if recommended. It’s also important to maintain a healthy lifestyle, including regular exercise and a balanced diet, to support overall heart health and recovery. Additionally, patients should be aware of any potential complications or symptoms to watch for and promptly contact their healthcare provider if they have any concerns.

Suitable For

Therefore, patients who are typically recommended for pericardiectomy are those with severe symptoms of constrictive pericarditis, especially if the cause of the disease is known (such as prior surgery or radiation). Older patients and those who may require additional procedures during surgery may also be candidates for pericardiectomy. It is important for patients to discuss their individual case with a healthcare provider to determine if pericardiectomy is the best treatment option for them.

Timeline

Before pericardiectomy:

  • Patient experiences symptoms of constrictive pericarditis, such as chest pain, shortness of breath, fatigue, and swelling in the legs
  • Diagnostic tests are performed, such as echocardiogram, CT scan, or MRI to confirm the diagnosis
  • Patient is evaluated by a cardiologist and a cardiac surgeon to determine if surgery is necessary
  • Patient undergoes pre-operative testing and preparation, including blood tests and imaging studies

After pericardiectomy:

  • Patient undergoes surgery to remove the stiffened pericardial sac surrounding the heart
  • Recovery in the hospital for several days to monitor for complications
  • Follow-up appointments with the cardiac surgeon and cardiologist to monitor healing and manage any ongoing symptoms
  • Rehabilitation and physical therapy to regain strength and endurance
  • Long-term follow-up care to monitor for recurrence of symptoms and assess overall heart function.

What to Ask Your Doctor

  1. What is the specific cause of my constrictive pericarditis and how does it affect my prognosis?
  2. What additional procedures may be necessary during the pericardiectomy surgery and how will they impact my recovery?
  3. What is the expected outcome of the surgery in terms of short-term and long-term survival rates?
  4. Will I require a heart-lung machine during the surgery and how does that affect the risks and benefits of the procedure?
  5. What are the potential complications or risks associated with pericardiectomy surgery and how are they managed?
  6. What is the recommended follow-up care and monitoring after the surgery to ensure optimal recovery and long-term success?
  7. Are there any lifestyle changes or medications that I should consider post-surgery to improve my overall heart health and reduce the risk of complications?
  8. How does my age and severity of symptoms factor into my individual prognosis and treatment plan?
  9. Are there any alternative treatment options or therapies that should be considered in conjunction with pericardiectomy surgery to improve outcomes?
  10. Are there any specific questions or concerns I should discuss with a cardiologist or other specialists before proceeding with the surgery?

Reference

Authors: Murashita T, Schaff HV, Daly RC, Oh JK, Dearani JA, Stulak JM, King KS, Greason KL. Journal: Ann Thorac Surg. 2017 Sep;104(3):742-750. doi: 10.1016/j.athoracsur.2017.05.063. Epub 2017 Jul 29. PMID: 28760468