Pericardiectomy, subtotal or complete; without cardiopulmonary bypass
CPT4 code
Name of the Procedure:
Pericardiectomy
Common name(s): Pericardial stripping
Summary
A pericardiectomy is a surgical procedure to remove part or all of the pericardium, the membrane surrounding the heart, without the use of cardiopulmonary bypass. This is typically performed when the pericardium becomes stiff or constricting, affecting heart function.
Purpose
Medical Condition: The procedure addresses constrictive pericarditis, a condition where the pericardium becomes thickened and restricts the heart’s movements.
Goals: The main goal is to relieve symptoms caused by the restrictive pericardium, improve heart function, and prevent further complications associated with constrictive pericarditis.
Indications
- Chronic constrictive pericarditis
- Symptoms such as severe chest pain, shortness of breath, and swelling in the abdomen or legs
- Diagnosed through imaging, and if conservative treatments have failed
Preparation
- Fasting: Patients are usually required to fast for at least 8 hours before the surgery.
- Medications: Adjustment of medications may be necessary; blood thinners are typically stopped a few days in advance.
- Diagnostic Tests: Echocardiogram, CT scan, or MRI to assess the condition of the pericardium.
Procedure Description
- Anesthesia: The patient is placed under general anesthesia.
- Incision: A surgical incision is made, either in the chest (median sternotomy) or on the side of the chest (thoracotomy).
- Removal of Pericardium: The surgeon carefully removes a portion (subtotal) or the entire pericardium (complete), ensuring not to damage the heart and vital structures.
- Closure: The incision is then closed with sutures or staples, and a drainage tube may be placed temporarily.
Tools and Equipment: Surgical scalpels, retractors, possibly surgical scissors or electrocautery devices.
Duration
Typically, the procedure takes between 2 to 4 hours.
Setting
A pericardiectomy is usually performed in a hospital’s sterile surgical operating room equipped with advanced monitoring and surgical equipment.
Personnel
- Surgeon: A cardiothoracic surgeon specializing in heart surgeries.
- Nurses: Scrub nurses and circulating nurses.
- Anesthesiologist: Manages general anesthesia and monitors patient vitals.
- Surgical Assistants: Assist the surgeon during the procedure.
Risks and Complications
- Common Risks: Infection, bleeding, and reactions to anesthesia.
- Rare Risks: Injury to the heart or surrounding tissues, postoperative complications such as heart arrhythmias or pleural effusion.
Benefits
The primary benefit is the alleviation of symptoms associated with constrictive pericarditis, leading to improved heart function and quality of life. Benefits are often realized shortly after recovery from surgery.
Recovery
- Post-Procedure Care: Monitoring in an intensive care unit (ICU) for the first 24-48 hours.
- Instructions: Pain management strategies, gradual increase in activity levels, and care for the surgical site.
- Recovery Time: Full recovery may take several weeks to months, with follow-up appointments to monitor progress.
Alternatives
- Medical Management: Use of anti-inflammatory drugs and diuretics to manage symptoms.
Pericardiocentesis: Draining excess fluid from the pericardium, though not a definitive treatment for constrictive pericarditis.
Pros and Cons: While medical management is less invasive, it typically does not resolve the underlying issue as effectively as a pericardiectomy.
Patient Experience
- During Procedure: As patients are under general anesthesia, they will be unconscious and pain-free.
- After Procedure: Pain and discomfort at the incision site, managed with medications. Patients might experience restrictions in activity and will need to adhere to specific postoperative care instructions.