Radical Pericardiectomy and Use of Cardiopulmonary Bypass for Constrictive Pericarditis

Background: Pericardiectomy is definitive treatment for constrictive pericarditis. However, extent of resection (radical versus partial) and use of cardiopulmonary bypass (CPB) are debated. Objectives: To determine the association of extent of pericardial resection and use of CPB with outcomes. Methods: From January 2000 to January 2022, 565 patients with constrictive pericarditis underwent radical (n=445, 314 [71%] on CPB) or partial (n=120, 67 [56%] on CPB) pericardiectomy at Cleveland Clinic. Outcomes stratified by extent of pericardial resection and use of CPB were compared after propensity-score matching. Results: Both radical pericardiectomy and CPB use (67% [381/565]) increased over time. Among 88 propensity-matched pairs (73% of possible matches), immediate postoperative cardiac index increased (P<0.001) in both groups by a median of 1.0 L{middle dot}min-1{middle dot}m-2. There were no significant differences between radical versus partial resection groups in occurrence of reoperation for bleeding (2.3%, [2/88] vs. 0, P=.50). Median postoperative hospital length of stay was 10 versus 8.5 days (P=.02). Operative mortality was 9.1% (8/88) versus 6.8% (6/88) (P=.58). 10-year survival was 54% versus 41%, with a higher propensity-adjusted hazard ratio after partial resection (1.9, 95% CI 1.2-3.1). Conclusions: When surgical intervention is deemed necessary, radical - rather than partial - resection for constrictive pericarditis can be performed with low surgical mortality and morbidity. Radical pericardiectomy can be accomplished on CPB and results in better long-term survival.