Outcomes After Pericardiectomy for Constrictive Pericarditis With a Strategy to Avoid Cardiopulmonary Bypass

BACKGROUND Pericardiectomy remains the definitive treatment for constrictive pericarditis, but the use of cardiopulmonary bypass (CPB) varies among centers. This study reports our center's experience 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. Primary outcome was survival via 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 and 5 years, survival was 92.9% [95% CI 87.1%, 99.1%] and 83.1% [95% CI 73.5%, 93.9%], while 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 due to iatrogenic injury during dissection. CONCLUSIONS In our single center experience, pericardiectomy without planned cardiopulmonary bypass was commonly performed with acceptable long-term survival, low perioperative morbidity, and a low conversion rate. These findings suggest CPB sparing approach may be feasible with proper operative planning and patient selection. However, further comparative studies are needed to define the optimal approach.