Pericardiectomy for constrictive pericarditis: short- and long-term outcomes in Sweden

Constrictive pericarditis can cause heart failure from restricted diastolic relaxation due to pericardial fibrosis. Pericardiectomy is the only curative treatment. However, evidence regarding factors associated with variation in outcomes after pericardiectomy remains limited. Therefore, we explored short- and long-term outcomes after pericardiectomy for constrictive pericarditis.

This nation-wide study included all pericardiectomy procedures for constrictive pericarditis in Sweden 1997-2020 (median follow-up 5.8 (IQR 2.5-10.1) years). Data were collected from the SWEDEHEART registry and two mandatory registries. Short- and long-term survival was analyzed. Long-term mortality was compared with an age and sex matched control group from the Swedish general population (n = 630).

We included 175 patients (mean age 59 ± 15 years). Extracorporeal circulation was common (47% of cases), and 26% of patients underwent concomitant cardiac surgery. In the pericardiectomy cohort, 30-day mortality was 5.1%, associated with older age at surgery (p = 0.008). During follow-up, 22% of patients were readmitted because of heart failure, associated with higher age at surgery (p = 0.02) and preoperative atrial fibrillation (p < 0.001). The long-term survival for pericardiectomy patients was poorer compared to the Swedish population controls in univariable analysis (HR 2.55, 95% CI 1.86-3.48). However, after multivariable adjustment for concomitant comorbidities, this association was attenuated (aHR 1.40, 95% CI 0.96-2.05).

Pericardiectomy for constrictive pericarditis is a rare procedure and risk of early mortality cannot be overlooked. However, only a low proportion of patients are rehospitalized due to heart failure during follow-up. Pericardiectomy patients show a high frequency of preoperative comorbidities, which appear to play a certain role in the postoperative period.