Outcome of pericardiectomy for constrictive pericarditis in Japan: A nationwide outcome study

Background: We evaluated the current results and the predictors of in-hospital complications for a pericardiectomy procedure for constrictive pericarditis in Japan. Methods: A total of 346 patients who underwent isolated pericardiectomy for constrictive pericarditis nationwide between 2008 and 2012 were identified from the Japan Adult Cardiovascular Surgery Database. Results: The patients were a mean age of 65.7 ± 11.7 years. The operative approach was through a median sternotomy in 90% of the patients. Cardiopulmonary bypass was used in 28.9%. The operative mortality rate was 10.0%, and the composite operative mortality or major morbidity (stroke, reoperation for bleeding, need for mechanical ventilation for more than 24 hours postoperatively due to respiratory failure, renal failure with newly required dialysis or mediastinitis) was 15.0%. Logistic regression analysis revealed that the predictive factors for composite operative mortality or major morbidity were preoperative chronic lung disease (odds ratio [OR], 4.75; p < 0.001), New York Heart Association functional class IV (OR, 3.85; p < 0.001), previous cardiac operation (OR, 2.68; p =.006), preoperative renal failure (OR, 2.62; p =.014), and cardiopulmonary bypass during the operation (OR, 2.46; p =.015). The frequency of using cardiopulmonary bypass was 2.9% in the patients treated through a left thoracotomy approach vs 31.8% in the patients treated through a median sternotomy approach (p < 0.0001). Conclusions: Pericardiectomy is associated with high morbidity and mortality rates. Careful consideration should be given to these risk factors in the process of patient selection and perioperative management.