ISSN : 1301-5680
e-ISSN : 2149-8156
Turkish Journal of Thoracic and Cardiovascular Surgery     
A risk scoring system comprised of right heart failure findings and the New York Heart Association functional classification parameters to predict mortality associated with pericardiectomies
Ayşen Aksöyek1, Ali Eba Demirbağ2, Seyhan Babaroğlu3, Ali İhsan Parlar4, İlknur Günaydın Bahar1, Zeki Çatav1, Ahmet Sarıtaş1, C. Levent Birincioğlu1
1Departments of Cardiovascular Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
2Departments of Gastrointestinal Surgery, Türkiye Yüksek İhtisas Training and Research Hospital, Ankara, Turkey
3Department of Cardiovascular Surgery, 29 Mayıs State Hospital, Ankara, Turkey
4Department of Cardiovascular Surgery, Akut Cardiovascular Hospital, İzmir, Turkey
DOI : 10.5606/tgkdc.dergisi.2015.10618
Background: This study aims to develop an easy and feasible risk scoring system by using right heart failure findings as well as New York Heart Association (NYHA) functional classification to predict the early and overall mortality rates in pericardiectomy.

Methods: One third of 79 consecutive patients (50 males, 29 females; mean age 40.0±16.7 years; range 14 to 75 years) who underwent isolated pericardiectomy at the same clinic between January 1997 and September 2010 were retrospectively evaluated and the remaining patients were included in the study prospectively. By adding findings of right heart failure (one point for each including dyspnea, edema, hepatomegaly, ascites, pleural effusion, hipoalbuminemia, and congestive liver dysfunction) and NYHA functional classification’s mathematical value, patients were separated into three categories as category 1 (≤6 points), category 2 (7-8 points), and category 3 (≥9 points). Effects of independent variables (sex, NYHA functional classification, symptoms lasting for more than one year, etiology, dyspnea, palpitation, chest pain, hepatomegaly, edema, ascites, atrial fibrillation, pleural effusion, hepatic and renal dysfunction, pericardial effusion and calcification, hyponatremia, hipoalbuminemia, echocardiographic findings, and need for positive inotropic medication) on early and overall mortalities were investigated with univariate and multivariate analyses.

Results: Mean follow-up period was 78.4±54.8 months, and early and overall mortality rates were 12.7% and 18.4%, respectively. While poor functional capacity, symptoms lasting for more than one year, ascites, pleural effusion, congestive liver dysfunction, renal dysfunction, pericardial calcification, hyponatremia, and postoperative positive inotropic medication need were significant risk factors in univariate analysis; advanced age, female sex, NYHA class, ascites, congestive liver dysfunction, hyponatremia, and the scoring system itself were significant risk factors in multivariate analysis. Early mortality rates were 0%, 15% and 70% (p=0.000), and overall mortality rates were 18.4%, 30%, and 70% for category 1, category 2, and category 3, respectively (p=0.004).

Conclusion: The early and overall mortality rates in pericardiectomy increase as do the number of right heart failure findings and NYHA functional capacity. The scoring system is a simple and feasible method to predict risk after pericardiectomy.

Keywords : Chronic pericarditis; constrictive pericarditis; pericardiectomy; risk assessment; risk factors
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