Eleven-Year Experience and Early Outcomes of Pericardiectomy for Constrictive Pericarditis

Abstract Constrictive pericarditis represents the end stage of chronic pericardial inflammation and is characterized by impaired diastolic filling due to pericardial fibrosis and/or calcification, leading to progressive right-sided heart failure. Pericardiectomy remains the definitive treatment, yet perioperative risk remains substantial in patients with advanced disease. We performed a retrospective single-center cohort study of 47 consecutive patients undergoing surgical pericardiectomy for constrictive pericarditis between January 2010 and December 2021. Perioperative characteristics, operative strategy, and early outcomes, including 30-day mortality, postoperative morbidity, and length of stay, were assessed. Mean age was 58 ± 14 years, and 64% of patients were male (n = 30). In the study 65% of patients presented with NYHA functional class III to IV, and operative risk was elevated, with a mean EuroSCORE II of 8.5 ± 2.3 and a mean STS score of 9.4 ± 2.3. Median sternotomy was used in 94% of patients (n = 44), radical pericardiectomy in 64% (n = 30), and a beating-heart strategy without cardiopulmonary bypass in 79% (n = 37), whereas cardiopulmonary bypass was required in 21% (n = 10). We found 30-day all-cause mortality was 6% (n = 3). Major postoperative complications included sepsis in 13% (n = 6) and renal failure requiring dialysis in 8.5% (n = 4). Mean ICU stay was 3.7 ± 4.5 days, and mean total hospital stay was 11 ± 6.7 days. Pericardiectomy for constrictive pericarditis can be performed with acceptable early mortality and morbidity even in a high-risk population. In experienced centers, an individualized surgical strategy prioritizing extensive pericardial resection with selective use of cardiopulmonary bypass appears feasible for the management of advanced disease.