Radical Pericardiectomy and Use of Cardiopulmonary Bypass for Constrictive Pericarditis

This study compared radical vs partial pericardiectomy in 534 consecutive adults with constrictive pericarditis from 2000 to 2022, using propensity-score matching to create 89 well-matched pairs. The authors found that radical pericardiectomy produced superior postoperative hemodynamics compared to partial resection, with cardiac index increases of 1.2 vs 0.5 liters per minute per square meter and central venous pressure decreases of 12 vs 4.8 mmHg (p<0.001). Operative mortality was significantly lower after radical pericardiectomy (3.4 percent vs 17 percent, p<0.05), with markedly improved 10-year survival (62 percent vs 23 percent). Cardiopulmonary bypass facilitated complete resection without increasing mortality risk, although there were increased transfusion requirements and bleeding complications noted. The authors concluded that radical pericardiectomy should be the preferred approach for constrictive pericarditis, as it can be performed safely with cardiopulmonary bypass support while providing superior short- and long-term outcomes.