Constrictive Pericarditis: The Effectiveness of Conservative Medical Therapy versus Surgical Pericardectomy

AUTHORS

Mohammad Mehdi Peyghambari ORCID 1 , Azin Alizadehasl ORCID 1 , Saman Rostambeigi ORCID 1 , * , Alireza Ghavidel ORCID 1 , Edalat Ghobadi ORCID 1 , Manoochehr Ebrahimian ORCID 2 , Niloufar Akbari Parsa ORCID 1 , Zohre Rahbar ORCID 1

1 Rajaie Cardiovascular, Medical, and Research Center, Iran University of Medical Sciences, Tehran, IR Iran

2 Resident of General Surgery, Shahid Beheshti University of Medical Sciences, Loghman Medical Center, Tehran, IR Iran

How to Cite: Peyghambari M M, Alizadehasl A, Rostambeigi S, Ghavidel A, Ghobadi E, et al. Constrictive Pericarditis: The Effectiveness of Conservative Medical Therapy versus Surgical Pericardectomy, Int Cardio Res J. 2020 ; 14(4):e110214.

ARTICLE INFORMATION

International Cardiovascular Research Journal: 14 (4); e110214
Published Online: December 15, 2020
Article Type: Research Article
Received: October 10, 2020
Accepted: December 09, 2020
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Abstract

Background: Pericarditis is an uncommon but important disease that can lead to severe
symptoms and mortality.
Objectives: This study aimed to evaluate the outcomes of constrictive pericarditis treated
by conservative medical therapy in comparison to surgical pericardiectomy.
Methods: In this retrospective study, the records of the patients diagnosed with
constrictive pericarditis in Rajaie Cardiovascular, Medical, and Research Center from
October 2007 to December 2017 were reviewed. Among the patients, 38 were treated by
medical therapy. Thus, 38 patients treated by surgical pericardiectomy were randomly
selected to be compared to the medical therapy group. The two groups were compared
with regard to the clinical outcomes. Intergroup comparisons were made using chisquare
test. In addition, Wilcoxon’s signed-rank test was used to compare the patients’
New York Heart Association (NYHA) functional classes before and after the treatment.
Statistical analysis was performed using IBM SPSS Statistics, version 16.
Results: The mean age of the patients was 51.68 ± 16.37 years in the medical therapy
group and 48.43 ± 17.04 years in the surgery group. The main symptoms were dyspnea
and edema. Besides, the most common causes were idiopathic (64.4%) and tuberculosis
(17.1%) followed by uremia (15.7%) and malignancy (6.5%). Moreover, 84.2% of the
patients in the medical therapy group and 97.3% of those in the surgical pericardiectomy
group experienced at least one NYHA functional class status, but the difference was
not statistically significant. Edema was decreased in 15 out of the 24 patients in the
medical therapy group (62.5%) and in 18 out of the 27 patients who had undergone
surgical percardiectomy (66.6%), but this difference was not statistically significant
(P = 0.74). Furthermore, nine patients in the conservative medical therapy group had
been re-hospitalized within the first year of treatment (23.8%), while this measure was
found to be six in the surgical pericardiectomy group (15.7%), and the difference was not
statistically significant (P = 0.3783). Finally, the perioperative mortality rate was 2.6%,
and long-term mortality rate was equal in the two groups (7.8%).
Conclusions: Conservative medical therapy based on the severity and cause of constrictive
pericarditis could improve clinical outcomes, especially in patients with transient types
of constrictive pericarditis as well as in those who were at a high risk for surgery.

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