Outcomes After Pericardiectomy for Constrictive Pericarditis With a Strategy to Avoid Cardiopulmonary Bypass
Background: Pericardiectomy remains the definitive treatment of constrictive pericarditis, but the use of cardiopulmonary bypass (CPB) varies between centers. This study reports our center's experience in performing pericardiectomy with a strategy to avoid CPB. Methods: We retrospectively reviewed consecutive adult patients undergoing radical pericardiectomy planned with or without CPB for constrictive pericarditis between 2013 and 2025. Radical pericardiectomies were performed in a phrenic-to-phrenic fashion. To facilitate optimal exposure, single-lung ventilation and suction cardiac positioners were employed. The primary outcome was survival by the Kaplan-Meier method. Secondary outcomes included freedom from heart failure–related readmission. Results: Of 84 pericardiectomies, 76 were planned without CPB. Freedom from postoperative transfusion within the first 48 hours was 77.6% for the planned without CPB group. Planned without CPB patients had an in-hospital and 30-day mortality of 1.3%. At 1 year and 5 years, survival was 92.9% (95% CI, 87.1%-99.1%) and 83.1% (95% CI, 73.5%-93.9%); freedom from heart failure–related readmission was 94.1% (95% CI, 88.7%-99.9%) and 91.6% (95% CI, 84.5%-99.2%). No patients required redo pericardiectomy. Two of the 76 patients required conversion to CPB because of iatrogenic injury during dissection. Conclusions: In our single-center experience, pericardiectomy without planned CPB was commonly performed with acceptable long-term survival, low perioperative morbidity, and a low conversion rate. These findings suggest that a CPB-sparing approach may be feasible with proper operative planning and patient selection. However, further comparative studies are needed to define the optimal approach.
