Pericardiectomy vs medical management in patients with relapsing pericarditis

Mayo Clin Proc. 2012 Nov;87(11):1062-70. doi: 10.1016/j.mayocp.2012.05.024.


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.

Publication types

  • Research Support, N.I.H., Extramural

MeSH terms

  • Adult
  • Aged
  • Chronic Disease
  • Echocardiography
  • Female
  • Follow-Up Studies
  • Hemodynamics
  • Humans
  • Male
  • Middle Aged
  • Minnesota
  • Pericardiectomy / statistics & numerical data*
  • Pericarditis, Constrictive / epidemiology*
  • Pericarditis, Constrictive / surgery*
  • Pericarditis, Tuberculous / epidemiology*
  • Pericarditis, Tuberculous / surgery*
  • Retrospective Studies
  • Secondary Prevention
  • Severity of Illness Index*
  • Survival Analysis
  • Time Factors
  • Treatment Outcome