Our Summary

This research paper discusses the findings of a study on a surgical procedure called total pericardiectomy, which was performed on 127 patients suffering from chronic constrictive pericarditis. This is a condition where the pericardium (the protective sac around the heart) becomes inflamed and stiff, causing discomfort and sometimes serious complications.

The surgery was done using a specific approach, from the left side of the chest, and without the use of cardiopulmonary bypass (a machine that takes over the heart’s function during surgery).

The results of the study showed that this method of surgery is safe and effective. Only a small percentage of patients (3.1%) passed away during or soon after the surgery, and an even smaller number (1.6%) died later on. Nearly a quarter of the patients (24.4%) had a low heart output after surgery, but none required additional surgeries.

Long-term, the procedure proved to be beneficial. After an average follow-up period of over eight years, 97.6% of the patients were still alive. Most of these survivors (93.4%) were classified as being in the best possible health category (New York Heart Association class I) at their last check-up.

In conclusion, performing a total pericardiectomy through the left side of the chest without using a heart-lung machine can effectively treat chronic constrictive pericarditis, with low risk and good long-term results.

FAQs

  1. What is the survival rate for patients who undergo total pericardiectomy?
  2. What postoperative complications can occur after a total pericardiectomy?
  3. What is the method used for total pericardiectomy in this study?

Doctor’s Tip

A helpful tip a doctor might tell a patient about pericardiectomy is to closely follow postoperative care instructions, including taking prescribed medications, attending follow-up appointments, and gradually increasing physical activity as recommended by your healthcare team. It is also important to report any new or worsening symptoms, such as chest pain, shortness of breath, or swelling, to your doctor promptly. Following these recommendations can help optimize your recovery and long-term outcomes after pericardiectomy.

Suitable For

Patients with chronic constrictive pericarditis who have failed medical management and have symptoms such as shortness of breath, fatigue, and fluid retention are typically recommended for pericardiectomy. This procedure is often considered for patients who have severe constriction of the pericardium causing impairment of cardiac function. Additionally, patients who have recurrent pericarditis or complications such as tamponade may also be candidates for pericardiectomy.

Timeline

Before pericardiectomy:

  • Patient may present with symptoms such as shortness of breath, chest pain, fatigue, and swelling in the legs
  • Diagnostic tests such as echocardiogram, CT scan, MRI, and cardiac catheterization may be performed to confirm the diagnosis of chronic constrictive pericarditis
  • Treatment may involve medications to manage symptoms, but ultimately surgery may be recommended if symptoms are severe and not responding to medication

After pericardiectomy:

  • Patient undergoes total pericardiectomy using a modified left anterolateral thoracotomy without cardiopulmonary bypass
  • Operative mortality rate is 3.1%, with no reoperations required for postoperative low cardiac output
  • Long-term survival rate is 97.6% at a median follow-up of 99 months
  • Most survivors are in New York Heart Association class I or II at their last follow-up, indicating improved heart function and quality of life

What to Ask Your Doctor

  1. What is involved in a pericardiectomy procedure?
  2. What are the potential risks and complications associated with pericardiectomy?
  3. Will I need to be on cardiopulmonary bypass during the surgery?
  4. How long is the typical recovery period after a pericardiectomy?
  5. What symptoms should I watch for after the surgery that may indicate a complication?
  6. Will I need any additional follow-up appointments or tests after the surgery?
  7. How likely is it that I will experience postoperative low cardiac output?
  8. Are there any specific lifestyle changes or precautions I should take after the procedure?
  9. What is the long-term outlook for individuals who undergo a pericardiectomy?
  10. Are there any factors that may increase my risk for complications during or after the surgery?

Reference

Authors: Chowdhury UK, George N, Singh S, Sankhyan LK, Sengupta S, Ray R, Vaswani P, Sharma S, Kalaivani M. Journal: Ann Thorac Surg. 2021 Nov;112(5):1483-1492. doi: 10.1016/j.athoracsur.2020.10.045. Epub 2020 Dec 10. PMID: 33310149