Does Cardiopulmonary Bypass Influence Outcomes After Pericardiectomy? Insights From a Single-Centre Experience

Objective Pericardiectomy for constrictive pericarditis remains a high-risk procedure with ongoing debate regarding cardiopulmonary bypass (CPB) use and extent of pericardial resection. We report a single-centre experience comparing off-pump versus on-pump and total versus partial pericardiectomy. Methods We retrospectively analysed 102 consecutive patients undergoing pericardiectomy at a tertiary cardiac surgical centre. Patients were stratified by CPB use (off-pump, n=29; on-pump, n=73) and extent of resection (total, n=89; partial, n=13). Primary outcomes included postoperative mortality, major morbidity, and survival. Multivariable penalised logistic regression (Firth's method) assessed predictors of mortality. Results Mean age was 64 ± 12 years and 28.4% were female. Total pericardiectomy was performed in 87.3%. Postoperative mortality was 6.9%. Low cardiac output syndrome and right ventricular failure each occurred in 48.9%. Operative urgency differed between off-pump and on-pump groups (p=0.01). Hospital stay was shorter off-pump (median 9 [IQR 6–14] vs 13 [8–20] days; p=0.10). Partial pericardiectomy was associated with longer cross-clamp time (85 ± 34 vs 45 ± 41 minutes; p<0.01), longer ITU stay, and higher EuroSCORE II. At median 36-month follow-up, 91% of survivors were NYHA class I/II. CPB was not independently associated with mortality (OR 0.62; 95% CI 0.06–7.05; p=0.67). NYHA class IV showed a large effect size (OR 15.97; p=0.08) without statistical significance. Conclusions CPB use was not associated with postoperative mortality. Advanced NYHA class and preoperative haemodynamic instability showed directional associations with mortality, consistent with published series, but did not reach statistical significance.