Name of the Procedure:

Pericardiectomy, Subtotal or Complete; with Cardiopulmonary Bypass

Summary

A pericardiectomy is a surgical procedure to remove part or all of the pericardium, the sac-like covering of the heart. In cases where a cardiopulmonary bypass is used, the procedure involves temporarily taking over the heart and lung functions to maintain blood circulation and oxygenation during surgery.

Purpose

A pericardiectomy is performed to treat constrictive pericarditis, a condition where the pericardium becomes thickened and restricts the heart's ability to function properly. The goal of the procedure is to relieve the constriction, improve heart function, and alleviate symptoms such as shortness of breath and swelling.

Indications

• Chronic constrictive pericarditis
• Recurrent pericardial effusion
• Pericarditis that does not respond to medical treatment
• Thickened or calcified pericardium causing heart function impairment

Preparation

• Fasting for 8 hours before the surgery
• Medication adjustments, particularly blood thinners
• Preoperative blood tests, echocardiography, CT or MRI scans of the heart
• Discussion of medical history and any existing health issues with the healthcare team

Procedure Description

1. The patient is given general anesthesia.
2. An incision is made in the chest to access the heart.
3. Cardiopulmonary bypass is established by connecting the patient to a heart-lung machine.
4. The pericardium is carefully dissected and removed, either partially (subtotal) or completely.
5. Any adhesions between the pericardium and heart are also removed.
6. Once the pericardium is removed, the heart-lung machine is gradually disconnected.
7. The incision is closed, and the patient is moved to the recovery area.

Duration

The procedure typically takes 3 to 5 hours.

Setting

Pericardiectomy is performed in a hospital's operating room equipped for cardiac surgery.

Personnel

• Cardiothoracic surgeon
• Anesthesiologist
• Surgical nurses
• Perfusionist (specialist managing the heart-lung machine)
• Surgical assistants

Risks and Complications

• Bleeding
• Infection
• Arrhythmias (irregular heartbeats)
• Heart injury
• Complications related to cardiopulmonary bypass
• Adverse reactions to anesthesia

Benefits

• Relief from symptoms such as shortness of breath, fatigue, and swelling
• Improved heart function
• Enhanced quality of life
• Long-term resolution of constrictive pericarditis

Recovery

• Postoperative care in an Intensive Care Unit (ICU) for monitoring
• Pain management and wound care instructions
• Gradual resumption of activities
• Follow-up appointments for ongoing assessment
• Full recovery typically takes 6 to 8 weeks, with some restrictions on physical activities.

Alternatives

• Medical management (anti-inflammatory medications, steroids)
• Percutaneous drainage of pericardial effusion
• Balloon pericardiotomy
• Each alternative has varying degrees of effectiveness and suitability depending on the patient's specific condition and overall health.

Patient Experience

During the procedure, the patient will be under general anesthesia and will not feel pain. Post-surgery, patients may experience chest pain and discomfort managed by pain medications. Breathing exercises and gradual physical activity are important components of recovery. The healthcare team will provide comprehensive support and monitoring to enhance comfort and ensure a smooth recovery.