From constriction to recovery: prognosis after pericardiectomy in constrictive pericarditis

Background Pericardiectomy is the treatment of choice for constrictive pericarditis (CP), yet contemporary data on long-term outcomes remain limited, particularly in heterogeneous real-world populations with varying surgical complexity. Purpose To evaluate overall and cardiovascular mortality, as well as heart failure (HF) rehospitalizations, in patients undergoing pericardiectomy for CP at a high-volume referral center. Methods We conducted a retrospective single-center study including consecutive patients who underwent pericardiectomy between 2000 and 2026. Baseline characteristics, etiology, surgical details, and postoperative outcomes were analyzed. The primary endpoint was all-cause and cardiovascular mortality. The secondary endpoint was HF rehospitalization during follow-up. Survival was assessed using Kaplan–Meier analysis. Results Forty-seven patients were included (median age 60 years [IQR 44–70], 72.3% male). Comorbidity burden was substantial: hypertension in 51.1%, chronic kidney disease in 42.6%, atrial fibrillation in 36.2%, dyslipidemia in 29.8%, diabetes in 19.1%, and prior cardiac surgery in 19.1%. Infectious and radiation-related causes predominated. Complete pericardiectomy was achieved in 57.4% of cases. Concomitant CABG was performed in 10.6%, reflecting procedural complexity. Median hospital stay was 10 days (IQR 5–17). Thirty-day mortality was 10.6%. Over a median follow-up of 2.9 years (1047 days), all-cause mortality was 23.4%, while cardiovascular mortality was 12.8%, occurring predominantly in the early postoperative period. HF rehospitalization occurred in 12.8% of patients. Kaplan–Meier analysis demonstrated 1-year survival of 83.7%, with median survival not reached. Patients surviving the perioperative phase showed stable mid-term clinical evolution with low rates of late cardiovascular events. Histopathology predominantly revealed chronic nonspecific fibrous pericarditis. Conclusion Pericardiectomy for constrictive pericarditis is a procedure of variable technical complexity, largely dependent on timing of referral and patient profile. When performed in experienced centers and in appropriately selected patients, surgery provides durable clinical benefit, favorable mid- to long-term survival, and a low rate of HF rehospitalizations. Early referral and multidisciplinary assessment are essential to optimize outcomes.