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Pericardiectomy Outcomes — EECC MCQ

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ModeratePericardial DiseasePericardiectomy OutcomesEECC

A 70-year-old woman with severe constrictive pericarditis refractory to medical therapy (3 months of colchicine + NSAIDs with no improvement, persistently elevated inflammatory markers, and ongoing restrictive physiology) undergoes pericardiectomy. What is the expected operative mortality?

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Correct answer: C — Pericardiectomy operative mortality is 5-10% — it is a major open-heart procedure requiring cardiopulmonary bypass in most cases; outcomes are better when performed before development of severe RV dysfunction, hepatic congestion, and renal impairment

Pericardiectomy (surgical removal of the pericardium) is the definitive treatment for chronic constrictive pericarditis refractory to medical therapy. The procedure involves: resection of as much pericardium as possible (radical pericardiectomy — from phrenic nerve to phrenic nerve), often requiring cardiopulmonary bypass (particularly when the pericardium is densely adherent to the epicardium). Operative mortality: 5-10% in contemporary series (higher in older patients, those with radiation-induced constriction, severe RV dysfunction, hepatic cirrhosis, or renal failure). The 2025 ESC Pericarditis Guidelines emphasise: (1) early referral BEFORE irreversible RV failure develops; (2) trial of anti-inflammatory therapy first (to identify transient constrictive pericarditis which may resolve medically); (3) pericardiectomy at experienced centres with high surgical volume. Long-term symptom improvement occurs in ~70-80% of patients.

Reference: ESC (2025): Myocarditis/Pericarditis Guidelines