Pericardiectomy

Overview

A pericardiectomy is a surgical procedure that involves the removal of either all or a portion of the pericardium, a double-walled membrane sac that envelops the heart. This procedure is often referred to as “pericardial stripping.” The pericardium contains a small amount of fluid that serves as a lubricant, preventing friction between the heart and the pericardium during its normal pumping action.

Typically, pericardiectomy is performed using an open heart surgery approach. Open-heart surgery involves making a larger incision, enabling cardiac surgeons to access and remove the entire pericardium surrounding the heart. When a minimally invasive technique is employed, there are limitations to how much of the pericardium can be removed.

Reasons for undergoing the procedure

Constrictive pericarditis, a condition in which your pericardium stiffens and may become calcified, is the most prevalent reason of pericardiectomy procedures.

Your heart cannot expand as it typically would during a beat because of this stiffness.

Then:

1.  The blood incompletely fills in your heart chambers.
2.  Blood back up into your lungs.
3.  Your heart is unable to pump in a normal manner.
4. Your abdomen and legs can swell.
5.  Symptoms of heart failure.

The best course of action for constrictive pericarditis is surgery in situations that are further advanced.

Among the causes of constrictive pericarditis are:

• Implying an unknown cause (idiopathic).
• Past cardiac surgery.
• Exposure to chest radiation.
• Conditions like tuberculosis and mesothelioma.
• Infection by a virus or bacteria.

Pericardiectomy is also indicated for people with:

• Recurrent pericarditis, or symptoms that return frequently.
• Adverse effects of anti-inflammatory drugs, such as steroids, administered for milder cases of pericardium constriction.
• Cardiac tamponade is uncommon. This is a puddle of fluid pressing against your heart.

Risks

One significant cardiac surgery procedure is the pericardiectomy. Select a cardiac surgeon with experience performing the operation to reduce risks.

Among the risks of pericardiectomy are:

• Atrial fibrillation
• Bleeding
• Profuse blood loss requiring blood transfusion
• Kidney problems
• Rarely, damage to the breathing-assistive phrenic nerve
• A mortality risk of 1% to 2%

The risk of complications following a pericardiectomy is elevated in individuals who have a history of radiation therapy, significant medical conditions, or prior heart surgeries.

Following the surgery, a minority of patients may continue to encounter issues.

Before the procedure

The surgeon will take meticulous steps to ensure that all necessary equipment is properly prepared for a safe surgical procedure. In all likelihood, the surgeon will employ the heart/lung machine, also known as cardiopulmonary bypass, to safely facilitate the removal of the pericardium surrounding your heart from its rear and sides.

During the procedure

The surgeon will undertake the following actions:

• To reach your heart, make an incision through your sternum, or breastbone, in the middle of your front ribs. We refer to this as a median sternotomy.
• Take out your heart’s pericardium.
• Wire the ribs and breastbone to one another.
• Use stitches to seal the wound.

A pericardiectomy typically has a duration of two to three hours for completion. However, some patients may undergo multiple procedures in the operating room.

After the procedure

Following your procedure, you may experience soreness upon awakening. One or more tubes may be employed to drain excess fluid from your chest.

On the day following surgery, you should be able to start with liquids and progress to solid food later in the day.

After the surgery, most patients will still need to take diuretics, although typically at lower doses than they were taking before the procedure.

Outcome

Most patients undergoing a pericardiectomy typically require a hospital stay lasting from five to seven days.

Once you return home, you can gradually resume your regular activities, except for lifting heavy objects.

A complete recovery following a pericardiectomy typically takes six to eight weeks, with the exact duration depending on the pre-existing condition of your health. For the most severe cases, the recovery period may extend beyond eight weeks.

Individuals with severe pericardial constriction who do not have additional cardiac or lung issues often experience a relatively swift recovery after surgery. Most patients begin to notice significant improvements within six to eight weeks, with gradual continued progress in the subsequent period.