Constrictive pericarditis in the modern era - Evolving clinical spectrum and impact on outcome after pericardiectomy

Background-The clinical spectrum of constrictive pericarditis (CP) has been affected by a change in incidence of etiological factors. We sought to det ermine the impact of these changes on the outcome of pericardiectomy. Methods ann Results-The contemporary spectrum of CP in 135 patients (76% ma le) evaluated at the Mayo Clinic from 1985 to 1995 was compared with that o f a historic cohort. Notable trends were an increasing frequency of CP due to cardiac surgery and mediastinal radiation and presentation in older pati ents (median age, 61 versus 45 years). Perioperative mortality decreased (6 % versus 14%, P=0.011), but late survival was inferior to that of an age- a nd sex-matched US population (57+/-8% at 10 years). The long-term outcome w as predicted independently by 3 variables in stepwise logistic regression a nalyses: (1) age, (2) NYHA class, and most powerfully, (3) a postradiation cause. Of 90 late survivors in whom functional class could be determined, f unctional status had improved markedly (2.6+/-0.7 at baseline versus 1.5+/- 0.8 at latest follow-up [P<0.0001]), with 83% being free of clinical sympto ms. Conclusions-The evolving profile of CP, with increasingly older patients an d those with radiation-induced disease in the past decade, significantly af fects postoperative prognosis. Long-term results of pericardiectomy are dis appointing for some patient groups, especially those with radiation-induced CP, By contrast, surgery alleviates or improves symptoms in the majority o f late survivors.