Pericardiectomy for Constrictive and Recurrent Pericarditis: State of the Art Update

Cardiac magnetic resonance imaging, echocardiography, and heart catheterization are complementary tools for diagnosis and management of patients considered for pericardiectomy. Radical pericardiectomy, unlike total/complete, represents the most extensive resection. Radical or total/complete pericardiectomy via median sternotomy is preferred over partial for both recurrent and constrictive pericarditis, to minimize the risk of symptoms and/or constriction recurrence. Utilization of cardiopulmonary bypass may facilitate the completeness and safety of the procedure. In surgical planning, attention should be paid to intraoperative challenges, especially low cardiac output syndrome, tricuspid regurgitation, and coronary injury. A multidisciplinary approach in experienced centers is essential to optimize outcomes. Radical or complete pericardiectomy is advised over partial to avoid the symptoms or constriction recurrence owing to the remaining pericardium. Further research is mandatory to identify the optimal timing and precise extent of pericardiectomy.