Our Summary

This research paper looks into a 15-year review of surgeries called pericardiectomies, which are performed to remove a part of the pericardium, the protective sack around the heart. The study analyzed patients who had these surgeries at their institution from 2005 to 2019.

They found that most of the patients had the surgery to treat constrictive pericarditis, a condition in which the pericardium becomes thick and rigid, making it difficult for the heart to function properly. Before the surgery, most of the patients had moderate heart disease (based on the New York Heart Association classification), and after the surgery, most had mild to moderate heart disease.

However, the study found that the mortality rates one, three, five, and ten years after the surgery were relatively high (ranging from 9.5% to 25.4%). There was also a 4.8% chance that the pericarditis would come back.

The study concluded that while the surgery does carry high mortality rates, this is likely due to the underlying heart conditions and other health problems the patients had. The outcomes were worse for patients who had previously had heart surgery, were on dialysis, or had compromised immune systems.

FAQs

  1. What is the purpose of pericardiectomy and what are its common indications?
  2. What were the mortality rates observed in the 15-year period of performing pericardiectomy at your institution?
  3. What factors were observed to be associated with worse outcomes after pericardiectomy?

Doctor’s Tip

One 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 avoiding strenuous activities until cleared by their healthcare provider. It is also important for patients to communicate any new or worsening symptoms to their doctor promptly. Additionally, maintaining a healthy lifestyle with regular exercise and a balanced diet can help improve long-term outcomes after pericardiectomy.

Suitable For

Patients who are typically recommended for pericardiectomy include those with constrictive pericarditis, hemorrhagic pericarditis, and other conditions causing significant constriction or compression of the heart due to the pericardium. These patients may have symptoms such as shortness of breath, chest pain, fatigue, and edema. Patients who have not responded to conservative treatment measures such as medications and pericardiocentesis may also be considered for pericardiectomy. Additionally, patients who have a history of prior cardiac interventions, dialysis, and immunocompromised states may be at higher risk for complications and poorer outcomes following pericardiectomy.

Timeline

  • Before pericardiectomy:
  1. Patient presents with symptoms of pericardial disease, such as chest pain, shortness of breath, fatigue, and swelling.
  2. Diagnostic tests are performed to confirm the presence of pericarditis, including echocardiogram, MRI, and CT scan.
  3. Treatment with medications, such as nonsteroidal anti-inflammatory drugs (NSAIDs) or corticosteroids, may be attempted initially.
  4. If conservative treatment fails, patient is scheduled for pericardiectomy, a surgical procedure to remove part or all of the pericardium.
  5. Preoperative evaluation includes assessment of patient’s overall health, comorbidities, and risk factors for surgery.
  • After pericardiectomy:
  1. Patient undergoes the surgical procedure, which may be performed through a median sternotomy or minimally invasive approach.
  2. Postoperatively, patient is monitored in the intensive care unit for complications such as bleeding, infection, and arrhythmias.
  3. Patient may experience pain and discomfort at the surgical site, which is managed with pain medications.
  4. Gradual improvement in symptoms of pericardial disease, such as resolution of chest pain and shortness of breath, is expected.
  5. Follow-up visits with the healthcare team are scheduled to monitor recovery and assess long-term outcomes, including survival and recurrence of pericarditis.

What to Ask Your Doctor

  1. What is the main reason for recommending a pericardiectomy in my case?
  2. What are the potential risks and complications associated with pericardiectomy?
  3. What is the expected recovery time after the surgery?
  4. Will I need any additional treatments or medications after the pericardiectomy?
  5. How will my quality of life be impacted after the surgery?
  6. Are there any lifestyle changes I should make before or after the surgery to improve the outcome?
  7. What is the success rate of pericardiectomy in patients with similar conditions to mine?
  8. How often will I need follow-up appointments after the surgery?
  9. Are there any specific symptoms I should watch out for after the surgery that may indicate a complication?
  10. What are the long-term outcomes and survival rates for patients who undergo pericardiectomy?

Reference

Authors: Faiza Z, Prakash A, Namburi N, Johnson B, Timsina L, Lee LS. Journal: J Cardiothorac Surg. 2021 Jun 22;16(1):180. doi: 10.1186/s13019-021-01561-4. PMID: 34158104