Pericardiectomy

A pericardiectomy is a surgical procedure to remove the pericardium, the membrane surrounding the heart. It is used to treat constrictive pericarditis, a cardiac condition in which the pericardium becomes stiff and inflamed. This prevents the heart from fully expanding when it beats, subsequently causing the blood to become backed up behind the heart, resulting in heart failure symptoms.

By removing all or a large part of the pericardium through this surgery, the heart can fully fill with blood again. While pericardiectomy enables the resumption of normal blood flow to and from the heart, it does not resolve the cause of the initial inflammation.

The pericardium, also called the pericardial sac, serves an important role in cardiac and pericardial function. As a fluid-filled fibrous sac that surrounds the heart, the pericardium acts as a protective layer to the heart and the connecting larger vessels. It also performs as a lubricant to decrease friction between the heart and neighboring structures.

When the pericardium becomes inflamed and stiffened during pericarditis, the lubricating function is no longer able to be performed and the abnormal structure puts the heart at risk.

Despite the vital role that it serves, removing the pericardium will not impact future heart health if the rest of the surrounding structures (lungs and diaphragm) are unharmed and healthy.

Is pericardiectomy an open-heart surgery?

Pericardiectomy is typically performed as an open-heart surgical procedure. Using a minimally invasive approach limits the amount of pericardium that can be removed. Creating a larger incision with open-heart surgery allows cardiac surgeons to have access to the entire pericardium around your heart for removal, rather than performing the lesser preferred partial pericardiectomy.

Someone with chronic constrictive pericarditis, as opposed to a singular occurrence of pericarditis, is an optimal candidate for pericardiectomy surgery. Constrictive pericarditis involves a more permanent thickening and scarring, which may benefit from a surgical intervention, whereas mild pericarditis may go away on its own.

Pericardiectomy may also be needed for:

• Recurring pericarditis, regardless of severity
• Pericardial effusion (buildup of fluid in the pericardium)
• Pericarditis that is not responding to or has complications from anti-inflammatory medication

Pericardiectomy is performed under general anesthesia, so your cardiac surgeon works closely with a cardiac anesthesiologist to ensure you’re safe and comfortable. Next, they:

• Make an incision through the breastbone to access the heart. You will be connected to a heart-lung machine, which takes over the work of your heart so it is still while the surgeon operates.
• Cut away all or part of the pericardium, allowing it to move and expand more freely.
• Perform other procedures. If you need other heart repairs, your surgeon can often perform them during the same operation. You benefit by undergoing general anesthesia only once.
• Close the incision

A pericardiectomy typically takes two to three hours to complete.

Immediately after surgery, your care team will move you to a recovery unit for close observation while you wake up. You will then move to the intensive care unit (ICU) where you will be cared for by a team of cardiac specialists. Patients are usually moved to a regular nursing floor within 24 hours with close monitoring until discharge.

To help you quickly return to an active lifestyle after surgery, you may benefit from cardiac rehab when you leave the hospital. Our rehabilitation specialists provide gentle exercises, nutrition guidance and support in an outpatient facility.

Recovery after a pericardiectomy takes between six to eight weeks on average.

Pericardiectomy offers several advantages as a treatment for constrictive pericarditis. Removing the inflamed and stiff pericardium eliminates the ability for any constriction and the symptoms it causes. Without a pericardium, patients often experience complete relief or only mild symptoms for several years post-surgery. The possibility of a complete cure for your constrictive pericarditis is much greater with surgery than with management through medication.

Most complications of the procedure are associated with certain risk factors. These include previous heart surgeries, existing severe cardiac and medical conditions or a history of radiation therapy (a possible cause of constrictive pericarditis). Complications that may occur with open-heart pericardiectomy surgery include bleeding, atrial fibrillation and infection.

Surgical care for pericarditis: Why choose Penn Medicine

• Surgical expertise: Our surgeons perform more than 3,000 procedures each year. Our high volumes translate into greater surgical expertise and better outcomes for you.
• Personalized treatment options: Though pericardiectomy is traditionally an open-heart procedure, Penn surgeons take a minimally-invasive approach whenever possible to improve healing and recovery time.
• Care close to home: Penn cardiac surgeons see patients at satellite locations across the community allowing convenient consultations, second opinions and pre- and post- operative care close to home.