Introduction
Mediastinal radiotherapy has been widely used over the years and has evolved to become one of the cornerstones of treatment for various types of thoracic cancers.1 However, the proximity of the radiation field to the heart can result in a sustained dose to cardiovascular structures, leading to radiation-associated cardiac disease (RACD).2 The cardiovascular complications of radiation include myocardial fibrosis, valvular abnormalities, coronary artery disease, pericarditis and conduction system dysfunction.3 While acute pericarditis has now become less common with modern radiation protocols, chronic pericarditis may manifest decades after treatment completion, often with resultant constriction.4
Constrictive pericarditis leads to a loss of pericardial compliance, with resultant diastolic heart failure.5Pericardiectomy has been the treatment of choice for constrictive pericarditis, resulting in symptomatic relief and improvement in functional status.6-11 Pericardiectomy performed for post-radiation constriction has been reported to generally have unfavorable outcomes but data are limited to small-sized studies7, 11-13. We sought to evaluate outcomes in a large cohort of patients undergoing pericardiectomy for constriction after mediastinal irradiation, and to analyze surgical approach, extent of resection, early mortality, and late survival.