Perioperative and Surgical Management of Constrictive Pericarditis

Constrictive pericarditis represents a form of severe diastolic heart failure characterized by impaired diastolic filling due to a rigid, noncompliant pericardium. Surgical pericardiectomy is the definitive treatment for chronic or refractory subacute constrictive pericarditis; however, outcomes vary widely depending on disease etiology, chronicity, myocardial involvement, end-organ dysfunction, and surgical technique. This review summarizes contemporary best practices for the surgical management of constrictive pericarditis, with emphasis on patient selection, timing of intervention, operative approach, and perioperative considerations. Accurate differentiation between inflammatory, transient constrictive phenotypes and irreversible fibrotic disease is central to therapeutic decision-making. Etiology-based risk stratification, assessment of hepatic and renal dysfunction, and careful evaluation of myocardial involvement provide critical prognostic information. Multimodality imaging plays a central role in diagnosis, surgical planning, and identification of patients most likely to benefit from intervention. Radical pericardiectomy is associated with superior functional recovery compared with partial resection, whereas radiation-associated disease, mixed constrictive–restrictive physiology, and advanced end-organ dysfunction are consistently linked to worse outcomes. High-volume centers of excellence in pericardial disease are critical in optimizing results after radical pericardiectomy.