Surgical outcomes of constrictive pericarditis and exploratory associations with inflammatory features: a 17-year single-center experience

Constrictive pericarditis (CP) remains a challenging disease with evolving etiological patterns and increasing emphasis on phenotype-based management. Pericardiectomy is the definitive treatment for CP. However, contemporary data on the etiological spectrum and the clinical relevance of inflammatory phenotypes in patients undergoing pericardiectomy are limited. We report the etiological spectrum, clinical phenotypes, and short- and long-term outcomes of pericardiectomy at a single center and explore whether a preoperative inflammatory phenotype is associated with adverse perioperative outcomes. We retrospectively analyzed 36 consecutive patients who underwent pericardiectomy for CP between 2007 and 2024. A study-defined inflammatory phenotype—preoperative pericardial effusion plus C-reactive protein > 10 mg/L ( n = 16)—was compared with all remaining patients ( n = 20). Patients were evaluated according to etiology, radiologic morphology, inflammatory status, perioperative outcomes, and long-term survival. Survival was estimated by the Kaplan–Meier method. The mean age was 46.1 ± 17.6 years and 69.4% were male. Idiopathic disease was the most common etiology (44.4%), followed by tuberculosis (22.2%), while several uncommon causes, including familial Mediterranean fever, post-transplantation, sarcoidosis, Erdheim–Chester disease and post-COVID pericarditis, were identified. Hypoalbuminemia was more frequent in the inflammatory phenotype group (62.5% vs. 20.0%; p = 0.016). The inflammatory phenotype was also associated with a higher incidence of postoperative LCOS ( p = 0.038). In-hospital mortality was observed in two patients (5.6%). After a median follow-up of 86.8 months, overall survival was 94.4%, 87.4% and 82.0% at 1, 5, and 10 years, respectively. Pericardiectomy for constrictive pericarditis provided favorable short- and long-term outcomes in this single-center cohort. A study-defined preoperative inflammatory phenotype was associated with higher perioperative risk in this exploratory cohort. These preliminary findings highlight the potential role of perioperative inflammatory assessment in surgical patients, though validation in larger prospective registries is required.