Surgical Treatment of Chronic Constrictive Pericarditis in a Developing Country

Background: Chronic constrictive pericarditis is a rare but serious clinical entity with a poor prognosis in the absence of surgical treatment. The purpose of this study was to report on our experience of subtotal anterior peri-cardectomy and analyze our surgical results. Results: We included 74 patients operated on for chronic constrictive pericarditis in our institution during the period from January 1985 to December 2020. There were 29 female and 45 male patients, with an average age of 28 years (range: 8 - 64 years). 36.5% of patients were in NYHA class III or IV. Physical signs were dominated by peripheral signs of right heart failure in 93.2% of cases. The surgical procedure was a subtotal anterior pericardectomy from the left to the right phrenic nerve, freeing the heart chambers and the large vessels. The surgical results were marked by a functional improvement in 82.4% of the cases. The post-operative complications were marked by a low cardiac output in 8.1% of the cases, a atrial fibrillation in 4.1% of the cases, a haemorrhage in 1.4% of the cases, a haemothorax in 2.7% of the cases. Perioperative mortality was 5.4% patients. The causes of death were low cardiac output in 50% of cases, hemorrhage in 25% of cases, and hepatocellular insufficiency in 25% of cases. We observed a mortality of 2.9% after an average follow-up of 5.17 years ± 4.76 years. All other survivors were asymptomatic and no re-intervention for recurrence was performed. Conclusions: Subtotal anterior pericardectomy was the technique we used for the treatment of chronic constrictive pericarditis. It allowed having satisfactory surgical results with a functional improvement and an acceptable morbidity.