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Current Cardiology Reports

, 21:6 | Cite as

Radical Pericardiectomy for Pericardial Diseases

  • Shinya Unai
  • Douglas R. JohnstonEmail author
Pericardial Disease (AL Klein and CL Jellis, Section Editors)
Part of the following topical collections:
  1. Topical Collection on Pericardial Disease

Abstract

Purpose of Review

The surgical management of constrictive pericarditis has evolved from a partial pericardiectomy via a thoracotomy approach to a more extensive removal of the pericardium. This review summarizes the published studies regarding surgical management of pericardial disease, focusing on the surgical technique of radical pericardiectomy for constrictive pericarditis.

Recent Findings

Anterior phrenic to phrenic resection without the use of cardiopulmonary bypass has been performed in many centers. This approach achieves improvement in symptoms; however, there are patients who have progressive constriction of the remaining pericardium requiring a completion pericardiectomy. Recent studies show that the survival and functional outcome is superior after a complete pericardiectomy.

Summary

Our approach is to perform a complete pericardiectomy using cardiopulmonary bypass. In experienced centers, the outcomes have significantly improved with careful selection of patients, advances in pre- and postoperative care, and refinement in surgical techniques.

Keywords

Pericardiectomy Constrictive pericarditis Recurrent pericarditis Cardiopulmonary bypass Cardiac surgery 

Notes

Compliance with Ethical Standards

Conflict of Interest

Shinya Unai and Douglas R. Johnston declare that they have no conflict of interest.

Human and Animal Rights and Informed Consent

This article does not contain any studies with human or animal subjects performed by any of the authors.

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

  1. 1.
    Delorme E. Sur un traitement chirurgical: De la symphyse cardopéricardique. Gaz Des Hôp. 1898;71:1150–1.Google Scholar
  2. 2.
    Rehn L. Ueber pericardiale Verwachsungen. Med Klin. 1920;16:991.Google Scholar
  3. 3.
    Churchill ED. Decortication of the heart (Delorme) for adhesive pericarditis. Arch Surg. 1929;19:1457.CrossRefGoogle Scholar
  4. 4.
    Mutyaba AK, Balkaran S, Cloete R, du Plessis N, Badri M, Brink J, et al. Constrictive pericarditis requiring pericardiectomy at Groote Schuur Hospital, Cape Town, South Africa: causes and perioperative outcomes in the HIV era (1990-2012). J Thorac Cardiovasc Surg. 2014;148(6):3058–65 e1.CrossRefGoogle Scholar
  5. 5.
    George TJ, Arnaoutakis GJ, Beaty CA, Kilic A, Baumgartner WA, Conte JV. Contemporary etiologies, risk factors, and outcomes after pericardiectomy. Ann Thorac Surg. 2012;94(2):445–51.CrossRefGoogle Scholar
  6. 6.
    Imazio M, Lazaros G, Brucato A, Gaita F. Recurrent pericarditis: new and emerging therapeutic options. Nat Rev Cardiol. 2016;13(2):99–105.CrossRefGoogle Scholar
  7. 7.
    Gillaspie EA, Stulak JM, Daly RC, Greason KL, Joyce LD, Oh J, et al. A 20-year experience with isolated pericardiectomy: analysis of indications and outcomes. J Thorac Cardiovasc Surg. 2016 Aug;152(2):448–58.CrossRefGoogle Scholar
  8. 8.
    Khandaker MH, Schaff HV, Greason KL, Anavekar NS, Espinosa RE, Hayes SN, et al. Pericardiectomy vs medical management in patients with relapsing pericarditis. Mayo Clin Proc. 2012 Nov;87(11):1062–70.CrossRefGoogle Scholar
  9. 9.
    Avgerinos D, Rabitnokov Y, Worku B, Neragi-Miandoab S, Girardi LN. Fifteen-year experience and outcomes of pericardiectomy for constrictive pericarditis. J Card Surg. 2014;29(4):434–8.CrossRefGoogle Scholar
  10. 10.
    Nishimura S, Izumi C, Amano M, Imamura S, Onishi N, Tamaki Y, et al. Long-term clinical outcomes and prognostic factors after pericardiectomy for constrictive pericarditis in a Japanese population. Circ J. 2017;81(2):206–12.CrossRefGoogle Scholar
  11. 11.
    Nataf P, Cacoub P, Dorent R, Jault F, Bors V, Pavie A, et al. Results of subtotal pericardiectomy for constrictive pericarditis. Eur J Cardiothorac Surg. 1993;7(5):252–5 discussion 5-6.CrossRefGoogle Scholar
  12. 12.
    Chowdhury UK, Subramaniam GK, Kumar AS, Airan B, Singh R, Talwar S, et al. Pericardiectomy for constrictive pericarditis: a clinical, echocardiographic, and hemodynamic evaluation of two surgical techniques. Ann Thorac Surg. 2006;81(2):522–9.CrossRefGoogle Scholar
  13. 13.
    •• Cho YH, Schaff HV, Dearani JA, Daly RC, Park SJ, Li Z, et al. Completion pericardiectomy for recurrent constrictive pericarditis: importance of timing of recurrence on late clinical outcome of operation. Ann Thorac Surg. 2012;93(4):1236–40 This study highlights the importance of radical pericardiectomy vs partial pericardiectomy. CrossRefGoogle Scholar
  14. 14.
    Rupprecht L, Putz C, Florchinger B, Zausig Y, Camboni D, Unsold B, et al. Pericardiectomy for constrictive pericarditis: an institution’s 21 years experience. Thorac Cardiovasc Surg. 2018;66:645–50.Google Scholar
  15. 15.
    Cho YH, Schaff HV. Surgery for pericardial disease. Heart Fail Rev. 2013;18(3):375–87.CrossRefGoogle Scholar
  16. 16.
    Gongora E, Dearani JA, Orszulak TA, Schaff HV, Li Z, Sundt TM 3rd. Tricuspid regurgitation in patients undergoing pericardiectomy for constrictive pericarditis. Ann Thorac Surg. 2008;85(1):163–70 discussion 70-1.CrossRefGoogle Scholar
  17. 17.
    Beckmann E, Ismail I, Cebotari S, Busse A, Martens A, Shrestha M, et al. Right-sided heart failure and extracorporeal life support in patients undergoing pericardiectomy for constrictive pericarditis: a risk factor analysis for adverse outcome. Thorac Cardiovasc Surg. 2017;65(8):662–70.CrossRefGoogle Scholar
  18. 18.
    Bertog SC, Thambidorai SK, Parakh K, Schoenhagen P, Ozduran V, Houghtaling PL, et al. Constrictive pericarditis: etiology and cause-specific survival after pericardiectomy. J Am Coll Cardiol. 2004;43(8):1445–52.CrossRefGoogle Scholar
  19. 19.
    Johnson TL, Bauman WB, Josephson RA. Worsening tricuspid regurgitation following pericardiectomy for constrictive pericarditis. Chest. 1993;104(1):79–81.CrossRefGoogle Scholar
  20. 20.
    Busch C, Penov K, Amorim PA, Garbade J, Davierwala P, Schuler GC, et al. Risk factors for mortality after pericardiectomy for chronic constrictive pericarditis in a large single-centre cohort. Eur J Cardiothorac Surg. 2015;48(6):e110–6.PubMedGoogle Scholar
  21. 21.
    Lin X, Xu RY, Liu JZ, Chen W, Chen LF, Yang PH, et al. Effect of right heart systolic function on outcomes in patients with constrictive pericarditis undergoing pericardiectomy. Chin Med J. 2016;129(2):154–61.CrossRefGoogle Scholar
  22. 22.
    • Murashita T, Schaff HV, Daly RC, Oh JK, Dearani JA, Stulak JM, et al. Experience with pericardiectomy for constrictive pericarditis over eight decades. Ann Thorac Surg. 2017;104(3):742–50 Large series study regarding the outcome of pericardiectomy which demonstrated that the long-term survival is determined by the etiology of constriction. CrossRefGoogle Scholar
  23. 23.
    Zhu P, Mai M, Wu R, Lu C, Fan R, Zheng S. Pericardiectomy for constrictive pericarditis: single-center experience in China. J Cardiothorac Surg. 2015;10:34.CrossRefGoogle Scholar
  24. 24.
    Kang SH, Song JM, Kim M, Choo SJ, Chung CH, Kang DH, et al. Prognostic predictors in pericardiectomy for chronic constrictive pericarditis. J Thorac Cardiovasc Surg. 2014;147(2):598–605.CrossRefGoogle Scholar
  25. 25.
    Szabo G, Schmack B, Bulut C, Soos P, Weymann A, Stadtfeld S, et al. Constrictive pericarditis: risks, aetiologies and outcomes after total pericardiectomy: 24 years of experience. Eur J Cardiothorac Surg. 2013;44(6):1023–8 discussion 8.CrossRefGoogle Scholar
  26. 26.
    Tiruvoipati R, Naik R, Loubani M, Billa G. Surgical approach for pericardiectomy: a comparative study between median sternotomy and left anterolateral thoracotomy. Interact Cardiovasc Thorac Surg. 2003;2(3):322–6.CrossRefGoogle Scholar
  27. 27.
    Thompson JL, Burkhart HM, Dearani JA, Cetta F, Oh JK, Schaff HV. Pericardiectomy for pericarditis in the pediatric population. Ann Thorac Surg. 2009;88(5):1546–50.CrossRefGoogle Scholar
  28. 28.
    Lin Y, Zhou M, Xiao J, Wang B, Wang Z. Treating constrictive pericarditis in a chinese single-center study: a five-year experience. Ann Thorac Surg. 2012;94(4):1235–40.CrossRefGoogle Scholar
  29. 29.
    Tokuda Y, Miyata H, Motomura N, Araki Y, Oshima H, Usui A, et al. Outcome of pericardiectomy for constrictive pericarditis in Japan: a nationwide outcome study. Ann Thorac Surg. 2013;96(2):571–6.CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Thoracic and Cardiovascular SurgeryCleveland ClinicClevelandUSA

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