Comparative outcomes of total versus partial pericardiectomy in constrictive pericarditis: A two-decade single-centre experience

Abstract Background The optimal extent of pericardial resection in constrictive pericarditis (CP) remains a subject of surgical debate. This study compared perioperative outcomes, postoperative right ventricular (RV) function, functional status, and long-term survival between total and partial pericardiectomy in a contemporaneous single-centre cohort. Methods A retrospective analysis was performed of 102 consecutive patients undergoing pericardiectomy for CP at a single tertiary cardiac surgical centre between 2005 and 2025. Patients were stratified by operative extent into total pericardiectomy (n = 89) and partial pericardiectomy (n = 13). Preoperative, operative, and postoperative variables were compared. Long-term survival was assessed by Kaplan–Meier analysis with log-rank testing. Results Patients in the partial group were older (67 ± 11 vs 63 ± 12 years; p = 0.240) with higher operative risk by EuroSCORE II (7.2 ± 4.6 vs 4.9 ± 2.7; p = 0.010) and logistic EuroSCORE (14.5 ± 19.3 vs 5.6 ± 6.8; p < 0.001). Urgent/emergency cases were more frequent in the partial group (61.5% urgent, 15.4% emergency vs 43.8% and 4.5%). Preoperative NYHA III–IV distribution was comparable (51.9% total vs 46.2% partial), as was preoperative RV function (p = 0.353). Conclusions Despite greater operative complexity, total pericardiectomy confers significantly superior long-term survival and functional recovery compared with partial resection. These data support total pericardiectomy as the standard of care for durable relief of CP, with appropriately selected use of cardiopulmonary bypass to facilitate complete biventricular decortication.