Recent surgical experience in chronic constrictive pericarditis

We reviewed the cases of 42 consecutive patients who underwent surgery for chronic constrictive pericarditis between January 1994 and January 2002, to determine causes, surgical techniques, mortality and morbidity rates, and improvement of functional capacity. Thirty-one of our patients were men (73.8%) and 11 were women (26.2%); their average age was 39.3 years. The pericarditis was tuberculous in 24 patients (57.1%), idiopathic in 10 (23.8%), rheumatic in 4 (9.5%), uremic in 2 (4.8%), and neoplastic in 2 (4.8%). In all cases, our approach was via median sternotomy. All anterior pericardium was resected from phrenic nerve to phrenic nerve. In 4 of 18 patients with calcific pericardial plaques, we could not develop a cleavage plane, so we left the plaques in place, reducing their size and relieving constriction by means of wedge incisions that reached the epicardium. No patient required cardiopulmonary bypass due to severe calcification or adhesion, but we did perform bypass with no difficulty in 5 patients who required additional cardiac surgery The early postoperative mortality rate was 11.9% (5 patients). In the 1st postoperative month, functional capacity improved dramatically: the number of patients in New York Heart Association functional class IV moved from 18 (preoperatively) to 1; in class III, from 20 to 6; in class II, from 4 to 13; and in class I, from 0 to 22. We recommend the median sternotomy approach for chronic constrictive pericarditis and consider cardiopulmonary bypass safe to use in indicated cases.