Abstract
Background
Constrictive pericarditis (CoPe) after open-heart surgery (OHS) is a rare complication. Information on the incidence, determinants, and prognosis of this condition has been scarcely reported.
Purpose
To investigate the long term prognosis of CoPe after OHS.
Methods
Using the Myocardial Infarction Data Acquisition System database, we analyzed records of 144,902 patients that had OHS in New Jersey hospitals between 1995 and 2015. CoPe was identified in 79 patients after discharge. Differences in proportions were analyzed using chi square. Cases and controls were matched for demographics and comorbidities. Cox proportional hazard models were used to evaluate outcome risks. Log-rank test was used to assess differences in the Kaplan-Meier survival curves.
Results
Patients with CoPe were more likely to have history of valve disease (HVD) (p<0.0001), atrial fibrillation (AF) (p=0.0006) and chronic kidney disease (CKD) (p=0.012). Significant predictors of CoPe were AF (HR 1.62, 95% CI 1.02–2.59), CKD (HR 2.70, 95% CI 1.53–4.76), diabetes (HR 1.73, 95% CI 1.08–2.80) and HVD (HR 3.11, 95% CI 1.88–5.15). Patients with CoPe compared to matched controls had a higher 10-year mortality (p<0.0001). This became a statistically significant difference at 6 years after surgery (Figure).
Survival Curve
Conclusion
Constrictive pericarditis is a rare complication of OHS and occurs more frequently in patients with AF, CKD, diabetes and HVD. It is associated with an unfavorable long-term prognosis. The data highlight the need for strategies to help prevent this complication.
Acknowledgement/Funding
Robert Wood Johnson Foundation
Long-term management of bradyarrhythmias following open heart surgery: Surgical A-V block and sick sinus syndrome after surgery for secundum atrial septal defects treated with permanent cardiac pacing.
