Radical pericardiectomy for chronic constrictive pericarditis

Background: We studied the impact of radical pericardiectomy on early and long-term patient survival, postoperative New York Heart Association (NYHA) functional class, and left ventricular ejection fraction in patients with chronic constrictive pericarditis compared to a sub-total pericardiectomy. Methods: From 1991 to 2016, 41 patients underwent pericardiectomy for chronic constrictive pericarditis. Sub-total pericardiectomy was performed in 17 (41%) and radical pericardiectomy in 24 (59%) patients. Patients in the two study groups had statistically similar NYHA functional class, left ventricular ejection fraction, and cardiac catheterization data. Follow-up was 100% complete with a median time of 4 years. Results: Radical pericardiectomy resulted in increased survival rates at 10 years (94%) compared to sub-total pericardiectomy (55%) (P = 0.014). In the idiopathic chronic constrictive pericarditis sub-group, long-term survival rates were also increased after a radical pericardiectomy (P = 0.001). Eighty-five percent of patients after a radical pericardiectomy were in NYHA functional class I or II after 5 years and 94% up to 25 years versus 53% and 63%, respectively, for the sub-total pericardiectomy group. Conclusions: Radical pericardiectomy provided superior 10-year survival and clinical functional improvement in patients with chronic constrictive pericarditis compared to sub-total pericaridectomy.