Elsevier

Mayo Clinic Proceedings

Volume 87, Issue 11, November 2012, Pages 1062-1070
Mayo Clinic Proceedings

Original article
Pericardiectomy vs Medical Management in Patients With Relapsing Pericarditis

https://doi.org/10.1016/j.mayocp.2012.05.024Get rights and content

Abstract

Objective

To determine whether surgical pericardiectomy is a safe and effective alternative to medical management for chronic relapsing pericarditis.

Patients and Methods

Retrospective review of 184 patients presenting to the Mayo Clinic in Rochester, Minnesota, from January 1, 1994, through December 31, 2005, with persistent relapsing pericarditis identified 58 patients who had a pericardiectomy after failed medical management and 126 patients who continued with medical treatment only. The primary outcome variables were in-hospital postoperative mortality or major morbidity, all-cause death, time to relapse, and medication use.

Results

Mean ± SD follow-up was 5.5±3.5 years in the surgical group and 5.4±4.4 years in the medical treatment group. At baseline, patients in the surgical group had higher mean relapses (6.9 vs 5.5; P=.01), were more likely to be taking colchicine (43.1% [n=25] vs 18.3% [n=23]; P=.002) and corticosteroids (70.7% [n=41] vs 42.1% [n=53]; P<.001), and were more likely to have undergone a prior pericardiotomy (27.6% [n=16] vs 11.1% [n=14]; P=.003) than the medical treatment group. Perioperative mortality (0%) and major morbidity (3%; n=2) were minimal. Kaplan-Meier analysis revealed no differences in all-cause death at follow-up (P=.26); however, the surgical group had a markedly decreased relapse rate compared with the medical treatment group (P=.009). Medication use was notably reduced after pericardiectomy.

Conclusion

In patients with chronic relapsing pericarditis in whom medical management has failed, surgical pericardiectomy is a safe and effective method of relieving symptoms.

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)

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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.

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