Pericardiectomy - Surgical Removal of the Pericardium

Overview

A pericardiectomy is the surgical removal of the pericardium. The goal of the procedure is to help the heart move more freely by removing damaged areas or the entire pericardium, the protective membrane around the heart. 

A pericardiectomy is a major cardiac procedure performed via open-heart surgery or minimally invasive, video-assisted thoracoscopy. 

While a pericardiectomy can help relieve your symptoms, it does not fix the problem that causes the inflammation.

Candidates for pericardiectomy (surgical removal of the pericardium)

Pericardiectomy is often recommended in patients with severe symptoms associated with chronic constrictive pericarditis that cannot be relieved with medical therapies. Patients with one instance of pericarditis are not candidates.

In a patient with chronic constrictive pericarditis, their pericardium is thick, stiff, and calcified, due to repeated scarring. The heart’s movement is affected by the scarring and leads to fatigue and swelling.

There are a variety of conditions that cause constrictive pericarditis, including:

• Autoimmune diseases
• Cancer in the heart or cancer that has spread from other areas of the body, such as mesothelioma
• Heart infection or in the pericardial sac
• Heart attack that causes inflammation of the pericardial sac
• Radiation therapy to the chest
• Tuberculosis
• Surgical complications

In some cases, the cause of constrictive pericarditis is not known.

A pericardiectomy may also be recommended to drain the extra fluid that has built up in the pericardium due to a pericardial effusion. A less invasive method to drain the fluid is used the first-time fluid builds up. If this method is not effective, a pericardiectomy may be an option.

Preparing for a pericardiectomy

Your surgeon will give you instructions on what to do in preparation for a pericardiectomy.

Guidelines include:

• Do not eat or drink anything after midnight before the day of the surgery.
• Stop taking medications outlined by your doctor before surgery.

Tests your doctor may recommend before surgery include:

• Chest X-ray
• ECG or EKG
• Blood tests
• Echocardiogram
• CT or MRI
• Heart catheterization

Expectations during a pericardiectomy

A pericardiectomy is performed in an operating room under general anesthesia and will take a few hours. Generally, you will need the help of a heart-lung machine to keep your blood pumping through the body during surgery. 

A pericardiectomy can be performed with open surgery or through minimally invasive techniques. 

During open surgery, your surgeon will make a large chest incision to access the heart. Using special surgical instruments, the surgeon will remove part of or the entire pericardium.

During minimally invasive surgery, your surgeon will make several small incisions on the side of the chest to access the heart and remove the pericardium. This is called video-assisted thoracoscopy or VATS. Your surgeon will use cameras and small tools to do the surgery through these holes. 

Your surgeon may also perform other heart repairs during the procedure. 

Recovering from a pericardiectomy

A pericardiectomy is major cardiac surgery. You will likely stay in the hospital for as long as seven days after the surgery. While in the hospital, your care team will monitor your vital signs such as heart rate, blood pressure, breathing, and oxygen level. You may need a drainage tube to remove excess fluid from your chest. Most patients feel sore after surgery, but not severe pain. Your heart symptoms should improve quickly after surgery.

Your doctor will give you strict discharge instructions such as:

• Do not lift anything heavy during the recovery period.
• Take medications as prescribed.
• You will likely need low doses of diuretics after surgery.
• Call the doctor if you develop a fever, increased drainage from the wound, increased chest pain, or other severe symptoms.

It may take as long as eight weeks to recover from a pericardiectomy fully. As a part of follow-up treatment, your doctor will order an echocardiogram to see how your heart functions. 

When to seek care

If you think you may need a pericardiectomy, start by voicing your concerns and symptoms to your primary care provider. From there, your doctor may suggest seeing a cardiologist for more specialized treatment.