What is pericardiectomy?
A pericardiectomy is a procedure done on the sac around the heart. A surgeon cuts away this sac or a large part of this sac. This allows the heart to move freely.
A fibrous sac called the pericardium surrounds the heart. This sac has two thin layers with fluid between them. This fluid reduces friction as the two layers rub against each other when the heart beats. Normally, this sac is thin and flexible, but repeated inflammation can cause it to become stiff and thick. When this happens, the heart can’t stretch properly as it beats. This can prevent the heart from filling up with as much blood as it needs. The lack of blood can cause increased pressure in the heart, a condition called constrictive pericarditis. Cutting this sac away allows the heart to fill normally again. Pericardiectomy, however, doesn’t fix the problem that was causing the inflammation.
Pericardiectomy is a surgery done under general anesthesia. The surgeon makes an incision over the breastbone to access the heart. Then the surgeon removes either a large part or the entire pericardium. Or, the surgeon makes an incision between the ribs to reach the pericardium. Doctors also may use a several small incisions on the side of the chest. This is called video-assisted thoracoscopy, or VATS. Small cameras and tools are used to do the surgery through these small holes.
Why might I need a pericardiectomy?
Pericardiectomy is most often needed in people with chronic constrictive pericarditis. It’s not usually an option for people who have had a single instance of pericarditis. With chronic constrictive pericarditis, the pericardium has become stiff and thick. This is due to repeated scarring. This scarring constricts the heart’s movement. This can cause symptoms like fatigue and swelling. Conditions that can cause constrictive pericarditis include:
- Infection of the heart or pericardial sac
- Radiation therapy to the chest
- Cancer (that has spread from elsewhere in the body or local cancer in the heart tissue itself)
- Inflammation of the pericardial sac due to a heart attack
- Autoimmune disease
- Reactions to certain drugs
- Metabolic causes, like an underactive thyroid
In some cases, the cause of constrictive pericarditis is unknown.
If you have severe symptoms, you may need a pericardiectomy. Medications may help your symptoms if you have chronic constrictive pericarditis. But surgery is the most helpful treatment.
In some cases, inflammation can cause a pericardial effusion. This is a buildup of fluid in the pericardium. This can make it difficult for the heart to beat normally. You may need a pericardiectomy to drain this fluid and prevent it from coming back. In most cases, a pericardiectomy is only done if problems with fluid buildup occur again. A less invasive method is often used for the first time fluid builds up around the heart.
What are the risks for pericardiectomy?
All procedures have some risks. The risks of pericardiectomy include:
- Low cardiac output syndrome
- Excess bleeding
- Fluid buildup around the lungs
- Blood clot (which can lead to stroke or other problems)
- Abnormal heart rhythms (which can cause death in rare instances)
- Heart attack
- Complications from anesthesia
Your own risks may vary according to your age, your general health, and the reason for your procedure/type of surgery you have. They may also vary depending on the anatomy of the heart, fluid, and pericardium. Talk with your healthcare provider to find out what risks may apply to you.
How do I prepare for a pericardiectomy?
Ask your doctor how to prepare for pericardiectomy. You should not eat or drink anything after midnight before the day of the surgery. Ask the doctor whether you need to stop taking any medications before the surgery.
The doctor may want some extra tests before the surgery. These might include:
- Chest X-ray
- Electrocardiogram (ECG), to check the heart rhythm
- Blood tests, to assess general health
- Echocardiogram, to view heart anatomy and blood flow through the heart
- CT or MRI, if the doctor needs more information about the heart
- Heart catheterization, to better examine the coronary blood vessels
Hair on and around the area of the operation may be removed ahead of time. About an hour before the operation, you may be given medicines to help you relax.
What happens during a pericardiectomy?
Talk with the doctor about what to expect during the surgery. The details of your surgery will vary according to the exact kind of repair the doctor is doing. Usually, doctors do the repair without the use of a cardiopulmonary bypass (a heart-lung machine). During the repair, the team will carefully monitor your vital signs. In general:
- An anesthesiologist will give you general anesthesia before the surgery starts. You will sleep deeply and painlessly during the operation. You won’t remember it afterwards.
- The surgery will take several hours.
- There are different types of procedures that may be done:
- In some cases, the surgeon will make a vertical incision along the breastbone. This incision will be several inches long. To access the heart, the surgeon will separate the breastbone.
- The doctor will surgically remove a large portion of the pericardium or the entire pericardium.
- The doctor will do other repairs to the heart if needed.
- The muscle and the skin incisions will be closed and a bandage will be applied.
What happens after a pericardiectomy?
Ask your doctor about what to expect after the procedure. In general, after your pericardiectomy:
- You may be groggy and disoriented upon waking.
- Your vital signs, such as your heart rate, blood pressure, breathing, and oxygen levels, will be closely monitored.
- You may have a tube draining the fluid from your chest.
- The drained fluid may be sent to a lab for analysis.
- You may feel some soreness, but you shouldn’t feel severe pain. Pain medications are available if needed.
- Your heart symptoms will likely get better very soon after surgery.
- You will probably be able to have liquids the day after surgery. You can have regular foods as soon as you can handle them.
- You will probably need to stay in the hospital at least several days. This will partially depend on the reason you needed a pericardiectomy.
After you leave the hospital:
- You will probably have your stitches or staples removed in a follow-up appointment in 7 to 10 days. Be sure to keep all follow-up appointments.
- You should be able to resume normal activities relatively soon, but you may be a little more tired for a while after the surgery.
- Ask the doctor if you have any exercise limitations. Avoid heavy lifting.
- Call the doctor if you have fever, increased draining from the wound, increased chest pain, or any severe symptoms.
- Follow all the instructions your healthcare provider gives you for medications, exercise, diet, and wound care.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- The risks and benefits of the test or procedure
- When and where you are to have the test or procedure and who will do it
- When and how will you get the results
- How much will you have to pay for the test or procedure