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.