Risk factors for mortality after pericardiectomy for chronic XXXX in a large single-centre cohort.

@entity1 @entity1030 @entity3822 @entity177 @entity1001 @entity1167 @entity453 @entity1002
OBJECTIVES: @entity3822 ( @entity3822 ) is an uncommon disease with multiple causes and unclear clinical outcomes. To date, few publications have clearly defined risk factors of poor outcomes after surgery for @entity3822 . We performed a retrospective analysis of almost 100 @entity1 undergoing surgical treatment for @entity3822 at a single institution in order to identify risk factors for perioperative and long-term mortality. METHODS: A total of 97 consecutive @entity1 (67.0% male) undergoing surgery for @entity3822 at our institution from 1995 to 2012 were included in the study. @entity3822 was diagnosed either preoperatively by cardiac catheterization and appropriate imaging or during surgery. Preoperative and intraoperative risk factors for 30-day and late mortality were analysed using stepwise multivariate logistic and Cox regression analyses. Median follow-up was 1.23    3.96 years (mean 3.08    3.96 years). RESULTS: The mean @entity1 age was 60.0    12.5 years and the underlying aetiology was idiopathic (50.5%), prior cardiac surgery (15.5%), prior mediastinal radiation (9.3%), and miscellaneous (24.7%). All @entity1 underwent either radical (55.2%) or partial (44.8%) pericardiectomy. Concomitant procedures were performed in 54 (55.7%) @entity1 . The total procedure time was 197.0    105.0 min. Cardiopulmonary bypass (CPB) was used in 62 @entity1 with a corresponding CPB time of 124.8    68.4 min. In those @entity1 who underwent CPB, @entity1167 was performed in 53.2% of @entity1 with a mean cross-clamp time of 74.9    41.9 min. Overall 30-day, 1-year and 5-year survival rates were 81.4, 66.5 and 51.6%, respectively, without significant differences according to the underlying aetiology. Multivariate analysis revealed @entity1 with reduced @entity1002 ( @entity1002 ) [P = 0.01, odds ratio (OR) 3.6] and preoperative @entity1001 (P = 0.04, OR 3.5) to be at significant risk of early mortality. Long-term mortality was independently predicted by the presence of @entity453 ( @entity453 ) [P < 0.001, hazard ratio (HR) 6.44], @entity1030 (P = 0.001, HR 4.21) and preoperative @entity177 (P = 0.012, HR 1.8). Concomitant tricuspid valve repair (TVR) appeared to provide protective effect on the long-term survival (P = 0.07). CONCLUSIONS: Surgery for @entity3822 is associated with a significant risk based on the poor preoperative @entity1 status. Whenever justified, partial over radical pericardiectomy should be preferred and TVR should be indicated liberally. Reduced @entity1002 and @entity1001 were independent predictors for early mortality, whereas @entity453 , @entity1030 and @entity177 were risk factors for late mortality. Thus, an optimal timing for surgery on @entity3822 remains crucial to avoid secondary morbidity with an even worse natural prognosis.
