Original articlePericardiectomy vs Medical Management in Patients With Relapsing Pericarditis
Section snippets
Study Group
After approval by the Mayo Clinic Institutional Review Board, we retrospectively reviewed the medical records of 252 patients who presented to Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with a diagnosis of relapsing or recurrent pericarditis. The primary inclusion criterion was definite diagnosis of relapsing pericarditis. The clinical diagnosis of relapse was based on a prior diagnosis of acute pericarditis, subsequent recurrent chest pain, and one or
Results
A total of 184 patients were included in the study and were divided into a surgical group (pericardiectomy; n=58) and a medical group (isolated medical therapy; n=126). Mean follow-up was 5.5±3.5 years in the surgical group and 5.4±4.4 years in the medical treatment group. Follow-up at 30 days, 90 days, and 1 year was 95%, 93%, and 88%, respectively, for the surgical group and 97%, 95%, and 93%, respectively, for the medical treatment group.
Baseline characteristics are listed in TABLE 1, TABLE 2
Discussion
To our knowledge, this is the first study to compare pericardiectomy and medical management in patients with refractory relapsing pericarditis. We studied 184 patients with refractory relapsing pericarditis treated at our institution between January 1, 1994, and December 31, 2005, 58 of whom underwent pericardiectomy and 126 who received only medical treatment after the index visit. Baseline data for the 2 groups were similar, with the exceptions that the surgical group had more relapses and
Conclusion
With our current medical armamentarium for relapsing pericarditis, which includes NSAIDs, colchicine, corticosteroids, and immunosuppressive agents, most patients will be cured with appropriate medical therapy. However, there is still a group of patients who have refractory relapsing pericarditis, which notably compromises their quality of life. In this subset of patients, our study would suggest that pericardiectomy is safe and effective at reducing subsequent relapses when compared with
Acknowledgments
We gratefully acknowledge Dr Sharmi Shafi for her help with the preparation of the submitted manuscript.
References (16)
- et al.
Pericardial disease: diagnosis and management
Mayo Clin Proc
(2010) - et al.
Management, risk factors, and outcomes in recurrent pericarditis
Am J Cardiol
(2005) - et al.
Prognosis of idiopathic recurrent pericarditis as determined from previously published reports
Am J Cardiol
(2007) Recurrent pericarditis
Cardiol Clin
(1990)- et al.
Surgical management of pericardial diseases
Cardiol Clin
(1990) - et al.
Acute idiopathic pericarditis: clinical features, development and complications: prospective study of 101 cases [in Spanish]
Med Clin (Barc)
(1985) - et al.
Acute nonspecific pericarditis; clinical, laboratory, and follow-up considerations
Circulation
(1951) - et al.
Relapsing pericarditis
Heart
(2004)
Cited by (0)
Grant Support: This study was supported by grant 1 UL1 RR024150 from the National Center for Research Resources (NCRR), a component of the National Institutes of Health (NIH), and the NIH Roadmap for Medical Research. Its contents are solely the responsibility of the authors and do not necessarily represent the official view of NCRR or NIH. Information on NCRR is available at http://www.ncrr.nih.gov/. Information on Reengineering the Clinical Research Enterprise can be obtained from http://nihroadmap.nih.gov.