Constrictive Pericarditis: The Effectiveness of Conservative Medical Therapy versus Surgical Pericardectomy

Background:
Pericarditis is an uncommon but important disease that can lead to severe symptoms and mortality.
Objectives:
This study aimed to evaluate the outcomes of constrictive pericarditis treated by conservative medical therapy in comparison to surgical pericardiectomy.
Methods:
In this retrospective study, the records of the patients diagnosed with constrictive pericarditis in Rajaie Cardiovascular, Medical, and Research Center from October 2007 to December 2017 were reviewed. Among the patients, 38 were treated by medical therapy. Thus, 38 patients treated by surgical pericardiectomy were randomly selected to be compared to the medical therapy group. The two groups were compared with regard to the clinical outcomes. Intergroup comparisons were made using chi-square test. In addition, Wilcoxon’s signed-rank test was used to compare the patients’ New York Heart Association (NYHA) functional classes before and after the treatment. Statistical analysis was performed using IBM SPSS Statistics, version 16.
Results:
The mean age of the patients was 51.68 ± 16.37 years in the medical therapy group and 48.43±17.04 years in the surgery group. The main symptoms were dyspnea and edema. Besides, the most common causes were idiopathic (64.4%) and tuberculosis (17.1%) followed by uremia (15.7%) and malignancy (6.5%). Moreover, 84.2% of the patients in the medical therapy group and 97.3% of those in the surgical pericardiectomy group experienced at least one NYHA functional class status, but the difference was not statistically significant. Edema was decreased in 15 out of the 24 patients in the medical therapy group (62.5%) and in 18 out of the 27 patients who had undergone surgical percardiectomy (66.6%), but this difference was not statistically significant (P = 0.74). Furthermore, nine patients in the conservative medical therapy group had been re-hospitalized within the first year of treatment (23.8%), while this measure was found to be six in the surgical pericardiectomy group (15.7%), and the difference was not statistically significant (P = 0.3783). Finally, the perioperative mortality rate was 2.6%, and long-term mortality rate was equal in the two groups (7.8%).
Conclusions:
Conservative medical therapy based on the severity and cause of constrictive pericarditis could improve clinical outcomes, especially in patients with transient types of constrictive pericarditis as well as in those who were at a high risk for surgery.