Radical Pericardiectomy and Use of Cardiopulmonary Bypass for Constrictive Pericarditis

Pericardiectomy is a definitive treatment for constrictive pericarditis. However, the extent of resection and cardiopulmonary bypass (CPB) use remain debated. We therefore compared hemodynamic changes, complications, long-term survival, and use of CPB in propensity-matched patients after radical vs partial pericardiectomy.

From 2000 through 2022, 534 consecutive adults with constrictive pericarditis underwent pericardiectomy, comprising radical in 425 (345 [81%] on CPB) and partial in 109 (68 [62%] on CPB) at Cleveland Clinic. Cardiac index, central venous pressure, procedural complications, and time-related mortality were compared in 89 well-matched pairs.

Radical pericardiectomy and CPB use increased over time. Among 89 propensity-matched pairs, postoperative cardiac index increased by 1.2 L/min/m² (15th-85th percentiles, 0.8-1.7 L/min/m²) after radical vs 0.5 L/min/m² (15th-85th percentiles, 0.1-1.0 L/min/m²) after partial resection (P < .001); central venous pressure decreased 12 (SD, 5.8) mm Hg after radical vs 4.8 (SD, 5.0) mm Hg after partial resection (P < .001). Operative mortality was 3.4% (3 of 89) vs 17% (15 of 89; P = .0029). Ten-year survival was 62% vs 23% (adjusted hazard ratio, 3.1; 95% CI, 2.1-4.6). More transfusion of blood products and reoperations for bleeding were observed with use of CPB, but survival did not differ by CPB use.

When pericardiectomy for constriction is necessary, radical rather than partial pericardiectomy can be performed with low surgical mortality and morbidity. Radical pericardiectomy results in better early and long-term survival. It can be accomplished on CPB without added survival risk.