Contemporary Techniques of Pericardiectomy for Pericardial Disease

Pericardiectomy is a potentially curative treatment for constrictive pericarditis. We use a median sternotomy and believe that adequate resection involves removal of the diaphragmatic pericardium and the anterior pericardium. Late outcomes depend on severity of right-sided heart failure preoperatively, the etiology of constrictive pericarditis, and adequate pericardial resection. Late results are excellent in patients with idiopathic disease or those with pericarditis secondary to prior cardiac operations. However, survival is reduced in those with radiation-induced constrictive pericarditis, primarily owing to additional secondary effects of radiation on cardiac valves, epicardial coronary arteries, and ventricular myocardium where fibrosis may cause associated restrictive cardiomyopathy.