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

Christopher Gaisendrees1, Llija Djordjevic2, Geor Schlachtenberger1

  • 1Faculty of Medicine, University of Cologne, Cologne, Germany.

The Thoracic and Cardiovascular Surgeon
|May 13, 2026
PubMed

Insights

Surgical pericardiectomy for constrictive pericarditis is feasible in high-risk patients, showing acceptable early outcomes. An individualized approach with extensive pericardial resection and selective cardiopulmonary bypass use is effective for advanced disease.

Area of Science:

  • Cardiovascular Surgery
  • Thoracic Surgery
  • Cardiac Surgery

Background:

  • Constrictive pericarditis is the advanced stage of chronic pericardial inflammation, leading to diastolic dysfunction and right-sided heart failure.
  • Pericardiectomy is the definitive treatment, but carries significant perioperative risks, especially in patients with severe disease.

Purpose of the Study:

  • To evaluate the perioperative characteristics and early outcomes of surgical pericardiectomy for constrictive pericarditis.
  • To assess the feasibility and safety of pericardiectomy in a high-risk patient cohort.

Main Methods:

  • Retrospective single-center cohort study of 47 patients undergoing pericardiectomy for constrictive pericarditis (2010-2021).
  • Analysis of perioperative data, surgical strategies (median sternotomy, radical pericardiectomy, beating-heart vs. cardiopulmonary bypass), and early outcomes (30-day mortality, morbidity, length of stay).

Main Results:

  • The study included 47 patients (64% male, mean age 58 years), with 65% in NYHA class III-IV and elevated operative risk scores (EuroSCORE II, STS).
  • Median sternotomy (94%) and radical pericardiectomy (64%) were common. A beating-heart strategy was used in 79%, with cardiopulmonary bypass in 21%.
  • 30-day mortality was 6%. Major complications included sepsis (13%) and renal failure requiring dialysis (8.5%). Mean ICU and hospital stays were 3.7 and 11 days, respectively.

Conclusions:

  • Pericardiectomy for constrictive pericarditis can be performed with acceptable early mortality and morbidity, even in high-risk populations.
  • An individualized surgical strategy, emphasizing extensive pericardial resection and selective cardiopulmonary bypass, is feasible and effective for managing advanced constrictive pericarditis in experienced centers.
Abstract

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