Pericardiectomy, also known as pericardial stripping, is a surgical procedure carried out to remove a portion, or all, of the pericardium. The pericardium is a thin, fluid-filled double-walled membrane sac that envelopes and protects the heart. The fluid ensures the lubrication of the heart during its normal pumping movements within the pericardium and prevents friction between the heart and the pericardium lining.
The major function of the pericardium is to protect the heart from infections and other sources of diseases and holds the heart in place in the chest wall. The pericardium also prevents the heart from over-expanding and ensures it continues to function normally when the blood volume increases due to conditions like kidney failure, pregnancy, or other causes.
Pericardiectomy is also the most common means of treatment for constrictive pericarditis. A condition where the pericardium has lost its ability to lubricate the heart and has become stiff and calcified, and does not allow the heart to stretch as it usually does when it pumps blood. This makes the heart swell up and develop symptoms of heart failure. This condition could occur as a result of – previous heart surgery, exposure to radiation in the chest area, complications from previous surgery, diseases (such as tuberculosis and mesothelioma), cancer of the heart tissue, and bacterial or viral infection
How is a pericardiectomy procedure carried out?
Prior to a pericardiectomy procedure, you’ll meet with the doctor carrying out the pericardiectomy procedure to discuss your medical history, the medications you take, and any questions you might have about the pericardiectomy procedure.
However, some examinations may be requested. These include – chest X-ray; ECG or EKG, to check the rhythm of the heart; blood tests, to assess the general health; Echocardiogram, to view the anatomy of the heart and pattern of blood flow through the heart; CT scan or MRI may be requested if the doctor needs more information about the status of the heart, and heart catheterization to estimate the pressures in the heart.
Preparing for a pericardiectomy procedure
At the commencement of the pericardiectomy procedure, a patient receives general anesthesia and thus will remain asleep for the duration of the pericardiectomy procedure, which may last several hours.
The surgeon starts by making an incision between the ribs, and spreads them apart with the aid of a mechanical spreader, thereby gaining access to the heart and the pericardium. The pericardium will then be carefully stripped off the heart and removed, along with the fluid in the area, as well any tumor growth.
Once this has been successfully completed, the surgeon closes up the incision made.
During the pericardiectomy procedure
The post-pericardiectomy procedure requires a hospital stay for one or two weeks. The length of the stay, however, varies by patient. While on the hospital stay, the patient continues to receive pain medication as required, and the recovery process is monitored by a doctor or nurse.
The first few weeks after a pericardiectomy procedure, there’s likely to be some complications such as severe pain, fever, redness, swelling or drainage from the incision site. If this occurs, the hospital stay may be longer.
After leaving the hospital, life after pericardiectomy will able to return to normal activities relatively soon, but you may still feel a little more tired for a while as a result of the surgery. Therefore, heavy lifting and strenuous activities should be avoided.
However, detailed information and instructions about life after pericardiectomy will be given by the doctor.
After the pericardiectomy procedure
Risks and complications
The pericardiectomy procedure is major cardiac surgery. Therefore, just like other surgeries, there are complications associated with the pericardiectomy procedure.
These pericardiectomy side effects may include:
These pericardiectomy side effects are more likely to be suffered by women, elderlies, and those who have chronic medical problems
Also, pericardiectomy side effects may vary according to age, anatomy of the heart, fluid, and pericardium, general wellbeing, and the reason for wanting to undergo a pericardiectomy procedure.
- Damage to the pleural cavities around the lungs, which can lead to either pneumonia or pleural effusion.
- Death, sometimes.
- Blood clots, which is likely to lead to stroke and other problems
- Complications may also occur from the anesthesia given
- Cardiac arrhythmias (abnormal heart rhythms), which may also lead to death in rare instances
- Low risk of hemorrhage, if perforation of the heart occurs whilst removing the pericardium.
- Severe bleeding, which may give rise to the need for a blood transfusion
- Cardiopulmonary bypass (this is, bypass of blood around a blocked vessel) may be required during the procedure.
- Heart attack
- Low cardiac output syndrome, that is, there is not enough oxygen getting out to the body
- Damage to the heart muscle
What is the pericardiectomy survival rate?
Outcomes of a pericardiectomy procedure depend significantly on the underlying cause, and the functionality of the kidneys, left ventricle, and pulmonary arteries.
Pericardiectomy survival rate from a pericardiectomy procedure carried out pericardial effusion is typically very good.
However, a pericardiectomy procedure carried out for the treatment of constrictive pericarditis has a fairly high mortality rate of between 5% and 15%. There is also an 80% 5-year survival rate. The most common pericardiectomy side effect is a reduced cardiac output, this occurs in 14% to 28% of patients.
Pericardiectomy side effects on Life Span
Pericardiectomy surgery may either improve prognosis or just alleviate symptoms. This all depends on the progression of the mesothelioma
For those whose cancer has already spread beyond the initial site, a pericardiectomy surgery has little effect on their life span
For those with less progressed forms of cancer, a pericardiectomy surgery could yield better results. In a mesothelioma patient, a pericardiectomy surgery was followed by a chemotherapy regimen. This combination laid cancer into remission and the patient remained free of it at a three-year follow-up.
How long does recovery from pericardiectomy surgery take?
Recovery from a pericardiectomy surgery is quite a long process. It requires a 1 to 2 weeks hospital stay post-surgery. Full recovery from a pericardiectomy surgery typically takes six to eight weeks. However, patients with severe pericarditis may take longer than eight weeks to fully recover.
Can the heart function normally without a pericardium?
The pericardium is not an essential tool required for the heart to function normally. In those with pericarditis, the pericardium has already has lost its capacity to function, so removing it neither worsens the situation nor causes problems, as long as the patient’s lungs and diaphragm are intact and functions normally.
Besides surgery, what other options are available for treating constrictive pericarditis?
For those with less severe pericardium constriction, there is an option of treatment with anti-inflammatory medications. For advanced cases, surgery is the best option for treatment.
Can a pericardiectomy surgery lead to death?
On very rare occasions, pericardiectomy surgery can lead to death, especially when abnormal heart rhythms occur as pericardiectomy side effects.