TY - JOUR
TI - Meta-Analysis of Population Characteristics and Outcomes of Patients Undergoing Pericardiectomy for Constrictive Pericarditis
AU - Tzani, A.
AU - Doulamis, I.P.
AU - Tzoumas, A.
AU - Avgerinos, D.V.
AU - Koudoumas, D.
AU - Siasos, G.
AU - Vavuranakis, M.
AU - Klein, A.
AU - Kampaktsis, P.N.
JO - AMERICAN JOURNAL OF CARDIOLOGY
PY - 2021
VL - 146
TODO - null
SP - 120-127
PB - HANLEY & BELFUS-ELSEVIER INC
SN - 0002-9149
TODO - 10.1016/j.amjcard.2021.01.033
TODO - age;  Article;  clinical evaluation;  clinical feature;  comorbidity;  constrictive pericarditis;  follow up;  gender;  human;  idiopathic disease;  long term care;  meta analysis;  mortality rate;  mortality risk;  New York Heart Association class;  outcome assessment;  pericardiectomy;  priority journal;  sensitivity analysis;  surgical mortality;  symptom;  treatment outcome;  tuberculous pericarditis;  constrictive pericarditis;  diagnostic imaging;  pericardiectomy;  procedures, Diagnostic Imaging;  Humans;  Pericardiectomy;  Pericarditis, Constrictive
TODO - We sought to systematically describe the epidemiology, etiology, clinical and operative characteristics as well as outcomes of patients who underwent pericardiectomy for constrictive pericarditis in the contemporary era. We conducted a systematic search of the MEDLINE, Embase, and Cochrane databases from their inception to April 1, 2020 for studies assessing the outcomes of pericardiectomy in patients with constrictive pericarditis. Studies with patients enrolled before 1985, pediatric patients or studies including >10% tuberculous pericarditis were excluded. The impact of pericarditis etiology on outcomes was evaluated with a meta-analysis. We analyzed 27 eligible studies and 2,114 patients. Etiology was most commonly idiopathic (50.2%), followed by after-cardiac surgery (26.2%) and radiation (6.9%). Patients were mostly men (76%), mean age 58 and with advanced symptoms (NYHA III/IV 70.1%). Total pericardiectomy was preferred (85.8%) and concomitant cardiac surgery was relatively common (23.8%). Operative mortality was 6.9% and 5-year mortality was 32.7%. Radiation and after-cardiac surgery patients had 3 and 2 times higher long-term risk for mortality respectively compared with idiopathic. A sensitivity analysis did not result in changes in the results. Thirty percent of included studies had more than low bias primarily originating from follow up and selection. Pericardiectomy is therefore performed mostly in middle-aged men with advanced symptoms and low co-morbidity burden and still caries significant operative mortality. Radiation and after-cardiac surgery patients have a significantly higher mortality risk compared with idiopathic. Several methodological issues and significant heterogeneity limit the generalization of these data and randomized controlled trials may have to be considered. © 2021 Elsevier Inc.
ER -