Radical Pericardiectomy and Use of Cardiopulmonary Bypass for Constrictive Pericarditis

BACKGROUND: Pericardiectomy is a definitive treatment for constrictive pericarditis. However, the extent of resection and cardiopulmonary bypass (CPB) use remain debated. We therefore compared hemodynamic changes, complications, long-term survival, and use of CPB in propensity-matched patients after radical vs partial pericardiectomy. METHODS: From 2000 through 2022, 534 consecutive adults with constrictive pericarditis underwent pericardiectomy, comprising radical in 425 (345 81% on CPB) and partial in 109 (68 62% on CPB) at Cleveland Clinic. Cardiac index, central venous pressure, procedural complications, and time-related mortality were compared in 89 well-matched pairs. RESULTS: ) after partial resection (P < .001); central venous pressure decreased 12 (SD, 5.8) mm Hg after radical vs 4.8 (SD, 5.0) mm Hg after partial resection (P < .001). Operative mortality was 3.4% (3 of 89) vs 17% (15 of 89; P = .0029). Ten-year survival was 62% vs 23% (adjusted hazard ratio, 3.1; 95% CI, 2.1-4.6). More transfusion of blood products and reoperations for bleeding were observed with use of CPB, but survival did not differ by CPB use. CONCLUSIONS: When pericardiectomy for constriction is necessary, radical rather than partial pericardiectomy can be performed with low surgical mortality and morbidity. Radical pericardiectomy results in better early and long-term survival. It can be accomplished on CPB without added survival risk.