Our Summary

This research looked at the causes and treatment of pericarditis, a condition where the sac-like covering around the heart (the pericardium) becomes inflamed. Traditionally, this was caused by infection, radiation, unknown causes, and inflammation. However, recently more cases are being caused by medical procedures, particularly a type of heart surgery called coronary artery bypass grafting (CABG).

The researchers looked at the records of 938 patients who had surgery to remove the pericardium (pericardiectomy) at their institution over a 20-year period. They found that 98 of these patients had previously had a CABG. The patients were mostly men, with an average age of 68. All had pericardiectomy due to pericardial constriction, a complication where the pericardium becomes stiff, preventing the heart from functioning properly.

The surgery was generally successful, with only a 3% early mortality rate. The researchers found that the use of a machine to take over the function of the heart and lungs during surgery (cardiopulmonary bypass) was associated with a lower overall survival rate, but this may reflect that these cases were more severe or complex. However, most patients saw a significant improvement in their heart function over the longer term.

In simpler terms, the study shows that surgery to remove the pericardium is generally safe and effective in patients who have had a previous CABG, despite the fact that these cases can be more complex.

FAQs

  1. What is pericarditis and what are its common causes?
  2. What is pericardiectomy and why is it performed?
  3. What were the main findings of this research on pericardiectomy?

Doctor’s Tip

A helpful tip for patients undergoing pericardiectomy, especially those who have had a previous CABG, is to discuss with your doctor the potential risks and benefits of the surgery. It’s important to understand that while the surgery may be more complex in these cases, it can still be successful in improving heart function in the long term. Be sure to follow your doctor’s recommendations for post-operative care and attend regular follow-up appointments to monitor your recovery.

Suitable For

Patients who are typically recommended for pericardiectomy are those who have pericardial constriction, a condition where the pericardium becomes stiff and hinders the heart’s function. This can be caused by various factors such as infection, radiation, unknown causes, inflammation, or as a complication of medical procedures like CABG. The study mentioned above found that patients who had previously undergone CABG and developed pericardial constriction benefited from pericardiectomy, with a low mortality rate and improved heart function in the long term.

Timeline

Before pericardiectomy:

  • Patient experiences symptoms of pericarditis, such as chest pain, shortness of breath, and fatigue
  • Diagnosis of pericarditis is made through physical examination, imaging tests, and possibly a pericardiocentesis (removal of fluid from the pericardium)
  • Patient may try conservative treatments such as medication and rest, but if symptoms persist or worsen, surgery may be recommended
  • Patient undergoes pre-operative evaluations and tests to ensure they are a suitable candidate for surgery

After pericardiectomy:

  • Patient undergoes surgery to remove the pericardium, either through open-heart surgery or minimally invasive techniques
  • Recovery period in the hospital, with monitoring of heart function and management of pain and any complications
  • Rehabilitation and physical therapy to regain strength and mobility
  • Follow-up appointments with healthcare providers to monitor recovery and heart function
  • Long-term management of any remaining symptoms or complications, with a focus on improving heart function and overall quality of life.

What to Ask Your Doctor

Some questions a patient should ask their doctor about pericardiectomy include:

  1. What are the risks and benefits of pericardiectomy for my specific condition?
  2. How will having had a previous CABG impact the success of the pericardiectomy surgery?
  3. What is the expected recovery time and potential complications following the surgery?
  4. Will I need any additional treatment or medication after the surgery?
  5. What lifestyle changes or restrictions should I follow post-surgery?
  6. How often will I need follow-up appointments to monitor my heart function?
  7. Are there any alternative treatments to pericardiectomy that I should consider?
  8. What can I do to optimize my chances of a successful outcome from the surgery?
  9. How experienced is the surgical team in performing pericardiectomy procedures?
  10. Are there any specific warning signs or symptoms I should watch for after the surgery that would require immediate medical attention?

Reference

Authors: Gillaspie EA, Dearani JA, Daly RC, Greason KL, Joyce LD, Oh J, Schaff HV, Stulak JM. Journal: Ann Thorac Surg. 2017 May;103(5):1429-1433. doi: 10.1016/j.athoracsur.2016.08.087. Epub 2016 Nov 5. PMID: 27825685