Pericardiectomy is a surgical procedure involving the removal of all or part of the pericardium, primarily used to treat patients with cardiac dysfunction caused by chronic pericarditis, pericardial adhesions, or long-term effusions. This operation alleviates the compression of the heart by the pericardium, restoring normal blood circulation and preventing restriction of cardiac expansion or contraction.
The surgery is typically indicated for conditions unresponsive to medication, such as constrictive pericarditis (caused by fibrosis, radiation therapy, or autoimmune diseases) or recurrent cardiac tamponade. In Taiwan, this procedure is usually performed by cardiothoracic surgeons under general anesthesia, with options for open thoracotomy or minimally invasive thoracoscopic approaches depending on the patient's condition.
Pericardiectomy can be classified into "total pericardiectomy" and "partial resection." Total pericardiectomy involves removing nearly all pericardial tissue to thoroughly address fibrosis or calcification; partial resection targets specific damaged areas while preserving some healthy tissue to maintain cardiac structural stability.
The physiological mechanism involves relieving the mechanical compression exerted by the pericardium on the heart, allowing the ventricles to expand and contract normally. Postoperatively, the fibrotic and rigid pericardial tissue is removed, enabling the heart to regain elasticity, which improves cardiac output and systemic hemodynamics.
Primarily indicated for chronic pericardial diseases unresponsive to medication, including:
This is a surgical treatment without a "dose" concept. The procedure includes:
Main benefits include:
The advantages include a high success rate, with international studies showing that over 80% of patients experience significant symptom relief within 12 months post-surgery. Thoracoscopic techniques further reduce tissue damage and recovery time.
Potential complications include:
A small number of patients may experience long-term symptoms postoperatively, such as residual pericardial fibrosis or chronic pain caused by surgical trauma. Close follow-up for at least one year is necessary to evaluate long-term outcomes.
Contraindications include: Within 30 days of acute myocardial infarction, uncontrolled coagulopathy, or severe systemic infections (such as sepsis). Patients with severe heart failure or pulmonary dysfunction should first receive supportive treatment before considering surgery.
Preoperative assessment of cardiac function and extent of disease is essential. Patients with bleeding disorders should temporarily discontinue anticoagulants. Postoperative follow-up includes regular ECG and echocardiography to ensure no re-growth of fibrotic tissue.
This surgery is often combined with pharmacotherapy:
Multicenter studies show that total pericardiectomy in constrictive pericarditis patients results in significant symptom improvement in 70-85% of cases within 6 months, with an average increase of 200 meters in the 6-minute walk test. Long-term follow-up indicates a survival rate exceeding 90% at 10 years.
Compared to medication, surgery addresses structural issues, whereas drugs only temporarily relieve inflammation. Imaging examinations (such as echocardiography or CT) can objectively evaluate improvements in cardiac function post-surgery.
Non-surgical alternatives include:
However, these methods only address symptoms and do not resolve fibrosis or calcification. For elderly patients or those with multiple organ failure, conservative treatment may be recommended instead of surgery.
Patients should undergo comprehensive examinations before surgery, including ECG, chest X-ray, and blood tests to assess cardiac function and exclude infection risks. The medical team will tailor anesthesia and surgical plans based on age, medical history, and type of pericardial disease. Certain medications may need to be discontinued 3 to 7 days prior to surgery, and detailed explanations and consent will be provided by the cardiac team.
What activities should be avoided during recovery?In the initial postoperative period, patients should avoid lifting heavy objects, vigorous exercise, and prolonged standing, typically for 2 to 4 weeks. Follow medical instructions to control activity levels and attend regular follow-up visits to monitor wound healing. Immediate reporting is necessary if fever, chest pain, or difficulty breathing occurs.
How is pain and complications managed after pericardiectomy?Pain is usually managed with analgesics, prescribed and monitored by the doctor. Signs of postoperative complications such as pericardial effusion or infection (e.g., persistent fever, wound redness or swelling) require prompt intervention, including drainage or antibiotics. Strict adherence to medication instructions and regular ultrasound follow-up are essential for recovery monitoring.
What dietary and lifestyle adjustments are recommended post-surgery?A low-sodium, high-protein diet is recommended to promote healing, along with avoiding alcohol and spicy foods. Blood pressure and blood sugar should be controlled, with gradual reintroduction of exercise such as walking. Strenuous activity should be avoided for at least 3 months. Smoking cessation is crucial, as nicotine can delay tissue repair and increase infection risk.
What is the success rate and long-term outlook of pericardiectomy?The success rate is approximately 80-90%, effectively alleviating symptoms caused by chronic pericarditis. Long-term follow-up shows about 90% of patients experience significant symptom improvement, but regular monitoring is necessary to detect potential complications early. Underlying conditions (such as renal failure or cancer) may affect overall prognosis, requiring ongoing communication with the healthcare team for care adjustments.
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