Outcomes of pericardiectomy for constrictive pericarditis following mediastinal irradiation

Siddharth Pahwa, Juan Crestanello, William Miranda, Annalisa Bernabei, Andreas Polycarpou, Hartzell Schaff, Joseph Dearani, John Stulak, Alberto Pochettino, Richard Daly, Brian Lahr, Jason Viehman, Kevin Greason

Research output: Contribution to journalArticlepeer-review


Background: Pericardiectomy for postradiation constrictive pericarditis has been reported to generally have unfavorable outcomes. This study sought to evaluate surgical outcomes in a large cohort of patients undergoing pericardiectomy for radiation-associated pericardial constriction. Methods: A retrospective analysis of all patients (≥18 years) who underwent pericardiectomy for a diagnosis of constrictive pericarditis with a prior history of mediastinal irradiation from June 2002 to June 2019 was conducted. There were 100 patients (mean age 57.2 ± 10.1 years, 49% females) who met the inclusion criteria. Records were reviewed to look at the surgical approach, the extent of resection, early mortality, and late survival. Results: The overall operative mortality was 10.1% (n = 10). The rate of operative mortality decreased over the study period; however, the test of the trend was not statistically significant (p =.062). Hodgkin's disease was the most common malignancy (64%) for which mediastinal radiation had been received. Only 27% of patients had an isolated pericardiectomy, and concomitant pericardiectomy and valve surgery were performed in 46% of patients. Radical resection was performed in 50% of patients, whereas 47% of patients underwent subtotal resection. Prolonged ventilation (26%), atrial fibrillation (21%), and pleural effusion (16%) were the most common postoperative complications. The overall 1, 5-, and 10-years survival was 73.6%, 53.4%, and 32.1%, respectively. Increasing age (hazard ratio, 1.044, 95% confidence interval 1.017–1.073) appeared to have a significant negative effect on overall survival in the univariate model. Conclusion: Pericardiectomy performed for radiation-associated constrictive pericarditis has poor long-term outcomes. The early mortality, though high (~10%), has been showing a decreasing trend in the test of time.

Original languageEnglish (US)
Pages (from-to)4636-4642
Number of pages7
JournalJournal of cardiac surgery
Issue number12
StatePublished - Dec 2021


  • mediastinal irradiation
  • operative mortality
  • pericardiectomy

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine


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