Experience With Pericardiectomy for Constrictive Pericarditis Over Eight Decades
Experience With Pericardiectomy for Constrictive Pericarditis Over Eight Decades
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DOI：
10.1016/j.athoracsur.2017.05.063
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发表时间：
2017-09-01
影响因子：
4.6
通讯作者：
Greason, Kevin L.
中科院分区：
文献类型：
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作者：
Murashita, Takashi;Schaff, Hartzell V.;Greason, Kevin L.
背景本研究的目的是回顾心包切除术治疗缩窄性心包炎的手术结果，并研究当代总体死亡率的危险因素。我们回顾了从1936年到2013年接受心包切除术的所有患者。研究包括术中确认的缩窄性心包炎病例，排除所有其他类型的心包炎;在1，066例患者中进行了1，071例心包切除术。患者分为两个时间段：历史组（1990年前）（n = 259）和当代组（1990-2013）（n = 807）。与历史组相比，当代组的患者年龄较大（61岁vs 49岁; p < 0.001），症状更多（NYHA III级或IV级分别为79.6% vs 71.2%; p < 0.001），更频繁地接受伴随手术（21.4% vs 5.4%; p < 0.001）。与狭窄病因大多为特发性（81.1%）的历史病例相反，近一半的当代病例为非特发性病因（术后32.3%，放射11.4%）。虽然30天死亡率从历史时期的13.5%下降到当代的5.2%（p < 0.001），但在调整患者特征后，总生存率相似。当代组总死亡率的危险因素包括NYHA III级或IV级（HR 2.17，p < 0.001）、放射病因（HR 3.93，p < 0.001）或心脏手术后病因（HR 1.47，p < 0.001）和是否需要体外循环（HR 1.35，p = 0.014）。在研究期间，疾病病因发生了显著变化。心包切除术后的长期生存率受患者特征的影响，包括狭窄的病因和症状的严重程度。(C)2017胸外科医师协会
Background. The purpose of this study was to review the surgical outcomes of pericardiectomy for constrictive pericarditis and to examine risk factors for overall mortality in a contemporary period.Methods. We reviewed all patients who underwent pericardiectomy for constriction from 1936 through 2013. The investigation included constrictive pericarditis cases confirmed intraoperatively, all other types of pericarditis were excluded; 1,071 pericardiectomies were performed in 1,066 individual patients. Patients were divided into two intervals: a historical (pre-1990) group (n = 259) and a contemporary (1990-2013) group (n = 807).Results. Patients in the contemporary group were older (61 versus 49 years; p < 0.001), more symptomatic (NYHA class III or IV in 79.6% versus 71.2%; p < 0.001), and more frequently underwent concomitant procedures (21.4% versus 5.4%; p < 0.001) compared with those in the historical group. In contrast to the historical cases in which the etiologies of constriction were mostly idiopathic (81.1%), nearly half of contemporary cases had a nonidiopathic etiology (postoperative 32.3%, radiation 11.4%). Although 30-day mortality decreased from 13.5% in the historical era to 5.2% in the contemporary era (p < 0.001), overall survival was similar after adjusting for patient characteristics. Risk factors of overall mortality in the contemporary group included NYHA class III or IV (HR 2.17, p < 0.001), etiology of radiation (HR 3.93, p < 0.001) or postcardiac surgery (HR 1.47, p < 0.001), and need for cardiopulmonary bypass (HR 1.35, p = 0.014).Conclusions. There was a significant change in disease etiology over the study period. Long-term survival after pericardiectomy is affected by patient characteristics including etiology of constriction and severity of symptoms. (C) 2017 by The Society of Thoracic Surgeons