Pericardiectomy for constrictive pericarditis: short- and long-term outcomes in Sweden.
Pericardiectomy for constrictive pericarditis carries a 30-day mortality risk of 5.1%, and while long-term survival appears poorer than the general population, this may be influenced by pre-existing comorbidities.
Where it sits
this study against the rest of the mgf (mechano growth factor) corpusSummary and findings
This study measured short- and long-term outcomes after pericardiectomy for constrictive pericarditis in Sweden from 1997 to 2020. A total of 175 patients were included, with a median follow-up of 5.8 years. The study found a 30-day mortality rate of 5.1% and long-term survival rates that were poorer compared to matched controls from the general population.
Abstract
<h4>Objectives</h4>Constrictive pericarditis can cause heart failure from restricted diastolic relaxation due to pericardial fibrosis. Pericardiectomy is the only curative treatment. However, evidence regarding factors associated with variation in outcomes after pericardiectomy remains limited. Therefore, we explored short- and long-term outcomes after pericardiectomy for constrictive pericarditis.<h4>Design</h4>This nation-wide study included all pericardiectomy procedures for constrictive pericarditis in Sweden 1997-2020 (median follow-up 5.8 (IQR 2.5-10.1) years). Data were collected from the SWEDEHEART registry and two mandatory registries. Short- and long-term survival was analyzed. Long-term mortality was compared with an age and sex matched control group from the Swedish general population (<i>n</i> = 630).<h4>Results</h4>We included 175 patients (mean age 59 ± 15 years). Extracorporeal circulation was common (47% of cases), and 26% of patients underwent concomitant cardiac surgery. In the pericardiectomy cohort, 30-day mortality was 5.1%, associated with older age at surgery (<i>p</i> = 0.008). During follow-up, 22% of patients were readmitted because of heart failure, associated with higher age at surgery (<i>p</i> = 0.02) and preoperative atrial fibrillation (<i>p</i> < 0.001). The long-term survival for pericardiectomy patients was poorer compared to the Swedish population controls in univariable analysis (HR 2.55, 95% CI 1.86-3.48). However, after multivariable adjustment for concomitant comorbidities, this association was attenuated (aHR 1.40, 95% CI 0.96-2.05).<h4>Conclusions</h4>Pericardiectomy for constrictive pericarditis is a rare procedure and risk of early mortality cannot be overlooked. However, only a low proportion of patients are rehospitalized due to heart failure during follow-up. Pericardiectomy patients show a high frequency of preoperative comorbidities, which appear to play a certain role in the postoperative period.
Background
This paper addresses the outcomes of pericardiectomy for constrictive pericarditis, a condition that can lead to heart failure due to restricted diastolic relaxation from pericardial fibrosis. Previous studies have indicated that pericardiectomy is the only curative treatment, but limited evidence exists regarding the factors that influence outcomes post-surgery. Understanding these outcomes is crucial for improving patient care and managing expectations.
Methods
This nationwide study included all pericardiectomy procedures for constrictive pericarditis in Sweden from 1997 to 2020, with a total of 175 patients and a median follow-up of 5.8 years (IQR 2.5-10.1). Data were collected from the SWEDEHEART registry and two mandatory registries. The primary outcomes measured were short- and long-term survival, with long-term mortality compared to an age and sex matched control group from the Swedish general population (n=630).
Results
The primary endpoint showed that the 30-day mortality rate was 5.1%, which was significantly associated with older age at surgery (p=0.008). During follow-up, 22% of patients were readmitted due to heart failure, which was associated with higher age at surgery (p=0.02) and preoperative atrial fibrillation (p<0.001). Long-term survival for pericardiectomy patients was poorer compared to matched controls (HR 2.55, 95% CI 1.86-3.48), but this association was attenuated after multivariable adjustment (aHR 1.40, 95% CI 0.96-2.05).
Interpretation
The findings suggest that while pericardiectomy can be associated with a significant early mortality risk, the long-term survival outcomes appear to be influenced by preoperative comorbidities. The effect size for long-term survival was statistically significant but may not be clinically meaningful after adjustment for confounders. The study's observational nature and the potential for confounding factors limit the strength of the conclusions drawn.
Key findings
- 30-day mortality was 5.1%, associated with older age at surgery (p=0.008).
- During follow-up, 22% of patients were readmitted because of heart failure, associated with higher age at surgery (p=0.02) and preoperative atrial fibrillation (p<0.001).
- Long-term survival for pericardiectomy patients was poorer compared to Swedish population controls (HR 2.55, 95% CI 1.86-3.48).
- After multivariable adjustment for concomitant comorbidities, the association with long-term survival was attenuated (aHR 1.40, 95% CI 0.96-2.05).
Limitations
- Observational study design limits causal inferences.
- Potential confounding factors related to comorbidities.
- Single-country study may limit generalizability.
- Median follow-up of 5.8 years may not capture long-term outcomes.