Clinical Features and Prognosis of Surgically Proven Constrictive Pericarditis Following Orthotopic Heart Transplantation

Abstract Constrictive pericarditis (CP) results in pericardial noncompliance and diastolic dysfunction. Definitive treatment is pericardiectomy, but data on CP following orthotopic heart transplantation (OHT) are limited. Accordingly, a retrospective review of eight cases of surgically proven CP post-OHT undergoing pericardiectomy was conducted. In this series, all patients were male. Median time to symptomatic CP following OHT was 1.7 years (0.8-18.1 years). Echocardiographic assessment was diagnostic for CP in three cases (38%). Cross-sectional imaging was performed in six cases, revealing ≥ mild pericardial thickening in all. Six patients (75%) underwent cardiac catheterization, which revealed CP in five (83%). Post-pericardiectomy 30-day mortality was 13% (one patient). Median survival following pericardiectomy was 2.3 years (18 days to 14.6 years), and 5-year survival 29%. Overall, CP post-OHT represents a subset of CP patients with high morbidity and mortality, and multimodality assessment is essential for its diagnosis. Despite relatively low surgical mortality, long-term survival is poor.