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Outcomes of Pericardiectomy for Constrictive Pericarditis following Mediastinal Irradiation
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  • Siddharth Pahwa,
  • Juan A. Crestanello,
  • William R. Miranda,
  • Annalisa Bernabei,
  • Andreas Polycarpou,
  • Hartzell Schaff,
  • Joseph Dearani,
  • John Stulak,
  • Alberto Pochettino,
  • Richard Daly,
  • Brian Lahr,
  • Jason Viehman,
  • Kevin Greason
Siddharth Pahwa
University of Louisville
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Juan A. Crestanello
Mayo Clinic
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William R. Miranda
Mayo Clinic
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Annalisa Bernabei
Mayo Clinic
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Andreas Polycarpou
Mayo Clinic
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Hartzell Schaff
Mayo Clinic
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Joseph Dearani
Mayo Clinic
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John Stulak
Mayo Clinc
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Alberto Pochettino
Mayo Clinic
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Richard Daly
Mayo Clinic
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Brian Lahr
Mayo Clinic
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Jason Viehman
Mayo Clinic
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Kevin Greason
MAYO CLINIC
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Abstract

Background Pericardiectomy for post-radiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction. Methods A retrospective analysis of all patients (≥18years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2±10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at surgical approach, extent of resection, early mortality and late survival. Results The overall operative mortality was 10.1% (n=10). The rate of operative mortality decreased over the study period; however, the test of trend was not statistically significant (P=0.062). Hodgkin’s disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery was performed in 46% patients. Radical resection was performed in 50% patients, whereas 47% patients underwent a subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%) and pleural effusion (16%) were the most common post-operative complications. The overall 1,5- and 10-years survival was 73.6%, 53.4% and 32.1% respectively. Increasing age (HR 1.044, 95%CI 1.017-1.073) appeared to have a significant negative effect on overall survival in the univariate model. Conclusion Pericardiectomy performed for radiation associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.

Peer review status:ACCEPTED

02 Jul 2021Submitted to Journal of Cardiac Surgery
02 Jul 2021Submission Checks Completed
02 Jul 2021Assigned to Editor
02 Jul 2021Reviewer(s) Assigned
24 Jul 2021Review(s) Completed, Editorial Evaluation Pending
24 Jul 2021Editorial Decision: Revise Minor
09 Aug 20211st Revision Received
10 Aug 2021Submission Checks Completed
10 Aug 2021Assigned to Editor
10 Aug 2021Reviewer(s) Assigned
12 Aug 2021Review(s) Completed, Editorial Evaluation Pending
12 Aug 2021Editorial Decision: Accept