Abstract
Background
Patient characteristics, trends in the management strategy, and outcomes of patients
with constrictive pericarditis have not been characterized at the national scale.
Methods
Annual trends of patients admitted to hospitals in the United States with constrictive
pericarditis were evaluated using the National Inpatient Sample dataset between 2005
and 2014. Poisson regression models adjusting for the US census population estimate
were fitted to evaluate trends in the incidence of constrictive pericarditis, isolated
pericardiectomy, and cardiopulmonary bypass (CPB) use. Descriptive analyses were performed
to compare patient characteristics and in-hospital mortality rates between surgically
and medically managed cohorts.
Results
During 2005-2014, 29,487 patients were admitted with constrictive pericarditis. Sixteen
percent underwent isolated pericardiectomy. The prevalence of constrictive pericarditis
remained stable between 2005 and 2014 at 9-10 cases per million, but proportion of
patients undergoing isolated pericardiectomy decreased from 18% in 2005 to 15% in
2014 (P = 0.001 for trend). CPB use increased from 15% to 29% (P < 0.001). Compared with medically managed patients, the pericardiectomy cohort was
younger (age 57 vs 61 years, P < 0.001), less likely to be female (25% vs 41%, P < 0.001), and harboured fewer comorbidities. In-hospital mortality was 7.3% for those
undergoing pericardiectomy and 6.8% for a medically managed cohort (P = 0.58) and operative mortality was stable across years (P = 0.99 for trend).
Conclusions
The prevalence of constrictive pericarditis remained stable between 2005 and 2014
at 9-10 cases per million. Surgical management was infrequent, with younger and less
comorbid patients being more likely to be managed operatively. Increasing use of CPB
without a change in operative mortality highlights the persisting challenge of this
complex disease.
Résumé
Contexte
Les caractéristiques des patients, les tendances en matière de stratégies de prise
en charge et le devenir des patients atteints de péricardite constrictive n’ont pas
été caractérisés à l’échelle nationale.
Méthodologie
Les tendances annuelles chez les patients atteints de péricardite constrictive hospitalisés
aux États-Unis ont été évaluées à partir des ensembles de données du National Inpatient
Sample couvrant la période allant de 2005 à 2014. Des modèles de régression de Poisson
corrigés pour tenir compte de l’estimation de la population américaine effectuée lors
du recensement ont été ajustés de façon à permettre l’évaluation tendancielle de la
fréquence de la péricardite constrictive, de la péricardectomie isolée et du recours
au pontage cardiopulmonaire (PCP). Des analyses descriptives ont été réalisées afin
de comparer les caractéristiques des patients et les taux de mortalité intrahospitalière
dans deux cohortes, l’une ayant été l’objet d’une prise en charge chirurgicale et
l’autre, d’une prise en charge médicale.
Résultats
De 2005 à 2014, 29 487 patients atteints de péricardite constrictive ont été hospitalisés.
Une péricardectomie isolée a été pratiquée chez 16 % d’entre eux. La prévalence de
la péricardite constrictive est demeurée stable entre 2005 et 2014, s’établissant
à 9 à 10 cas par million, mais la proportion de patients ayant subi une péricardectomie
isolée a diminué, passant de 18 % en 2005 à 15 % en 2014 (p = 0,001 pour la tendance). Le recours au PCP a augmenté, passant de 15 à 29 % (p < 0,001). Comparativement aux patients ayant été l’objet d’une prise en charge médicale,
les patients formant la cohorte des péricardectomisés étaient plus jeunes (57 ans
vs 61 ans, p < 0,001) et moins susceptibles d’être des femmes (25 % vs 41 %, p < 0,001) et ils présentaient moins de maladies concomitantes. Le taux de mortalité
intrahospitalière a atteint 7,3 % chez les patients péricardectomisés et 6,8 % chez
les patients de la cohorte ayant été l’objet d’une prise en charge médicale (p = 0,58), et la mortalité opératoire s’est avérée stable au fil des ans (p = 0,99 pour la tendance).
Conclusions
La prévalence de la péricardite constrictive est demeurée stable entre 2005 et 2014,
s’établissant à 9 à 10 cas par million. La prise en charge chirurgicale a été peu
fréquente; les patients plus jeunes et présentant moins de maladies concomitantes
étaient plus susceptibles d’en être l’objet. Le recours croissant au PCP en l’absence
de variation du taux de mortalité opératoire met en lumière le défi persistant que
représente cette maladie complexe.
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References
- Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy.J Am Coll Cardiol. 2004; 43: 1445-1452
- Predictors of in-hospital complications after pericardiectomy: a nationwide outcomes study.J Thorac Cardiovasc Surg. 2013; 145: 1227-1233
- Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study.Ann Thorac Surg. 2013; 96: 571-576
- Contemporary etiologies, risk factors, and outcomes after pericardiectomy.Ann Thorac Surg. 2012; 94: 445-451
- Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: causes and perioperative outcomes in the HIV era (1990-2012).J Thorac Cardiovasc Surg. 2014; 148 (3058-65.e3051)
- Treating constrictive pericarditis in a Chinese single-center study: a five-year experience.Ann Thorac Surg. 2012; 94: 1235-1240
- Complicated pericarditis: understanding risk factors and pathophysiology to inform imaging and treatment.J Am Coll Cardiol. 2016; 68: 2311-2328
- 2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the Task Force for the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology (ESC)Endorsed by: the European Association for Cardio-Thoracic Surgery (EACTS).Eur Heart J. 2015; 36: 2921-2964
- Surgical treatment of chronic constrictive pericarditis using cardiopulmonary bypass.J Thorac Cardiovasc Surg. 1975; 69: 236-238
- Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardiectomy.Circulation. 1999; 100: 1380-1386
- Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques.Ann Thorac Surg. 2006; 81: 522-529
- Pericardiectomy for constrictive pericarditis: 20 years of experience at the Montreal Heart Institute.Ann Thorac Surg. 2015; 100: 107-113
- Surgical experience on chronic constrictive pericarditis in African setting: review of 35 years' experience in Cote d'Ivoire.Cardiovasc Diag Ther. 2016; 6: S13-S19
- Surgical treatment of constrictive pericarditis.Texas Heart Institute J. 2017; 44: 101-106
- Experience with pericardiectomy for constrictive pericarditis over eight decades.Ann Thorac Surg. 2017; 104: 742-750
- Long-term clinical outcomes and prognostic factors after pericardiectomy for constrictive pericarditis in a Japanese population.Circulation J. 2017; 81: 206-212
- Surgical pericardiectomy for constrictive pericarditis: a single tertiary center experience [epub ahead of press].Thorac Cardiovasc Surg. 2018;
- HCUP Nationwide Inpatient Sample (NIS). 2004–2011. Agency for Healthcare Research and Quality, Rockville, MD.(Available at)http://www.hcup-us.ahrq.gov/nisoverview.jspDate accessed: January 9, 2018
- A 20-year experience with isolated pericardiectomy: analysis of indications and outcomes.J Thorac Cardiovasc Surg. 2016; 152: 448-458
- Sur un traitement chirurgical de la symphyse cardo-pericardique.Soc De Chir De Paris. 1898; : 918-922
Article info
Publication history
Published online: May 20, 2019
Accepted:
May 14,
2019
Received:
January 18,
2019
Footnotes
See page 1398 for disclosure information.
Identification
Copyright
© 2019 Canadian Cardiovascular Society. Published by Elsevier Inc. All rights reserved.
