Radical Pericardiectomy for Pericardial Diseases

Purpose of Review: The surgical management of constrictive pericarditis has evolved from a partial pericardiectomy via a thoracotomy approach to a more extensive removal of the pericardium. This review summarizes the published studies regarding surgical management of pericardial disease, focusing on the surgical technique of radical pericardiectomy for constrictive pericarditis. Recent Findings: Anterior phrenic to phrenic resection without the use of cardiopulmonary bypass has been performed in many centers. This approach achieves improvement in symptoms; however, there are patients who have progressive constriction of the remaining pericardium requiring a completion pericardiectomy. Recent studies show that the survival and functional outcome is superior after a complete pericardiectomy. Summary: Our approach is to perform a complete pericardiectomy using cardiopulmonary bypass. In experienced centers, the outcomes have significantly improved with careful selection of patients, advances in pre- and postoperative care, and refinement in surgical techniques.