What is pericardiectomy?
A pericardiectomy is a procedure done on the sac around the heart. A surgeon cuts
away this sac or a large part of this sac. This allows the heart to move freely.
A fibrous sac called the pericardium surrounds the heart. This sac has two thin layers
with fluid between them. This fluid reduces friction as the two layers rub against
each other when the heart beats. Normally, this sac is thin and flexible, but repeated
inflammation can cause it to become stiff and thick. When this happens, the heart
can’t stretch properly as it beats. This can prevent the heart from filling up with
as much blood as it needs. The lack of blood can cause increased pressure in the heart,
a condition called constrictive pericarditis. Cutting this sac away allows the heart
to fill normally again. Pericardiectomy, however, doesn’t fix the problem that was
causing the inflammation.
Pericardiectomy is a surgery done under general anesthesia. The surgeon makes an incision
over the breastbone to access the heart. Then the surgeon removes either a large part
or the entire pericardium. Or the surgeon makes an incision between the ribs to reach
the pericardium. Doctors also may use a several small incisions on the side of the
chest. This is called video-assisted thoracoscopy or VATS. Small cameras and tools
are used to do the surgery through these small holes.
Why might I need a pericardiectomy?
Pericardiectomy is most often needed in people with chronic constrictive pericarditis.
It’s not usually an option for people who have had a single instance of pericarditis.
With chronic constrictive pericarditis, the pericardium has become stiff and thick.
This is due to repeated scarring. This scarring constricts the heart’s movement. This
can cause symptoms like fatigue and swelling. Conditions that can cause constrictive
- Autoimmune disease
- Cancer (that has spread from elsewhere in the body or cancer in the heart tissue itself)
- Infection of the heart or pericardial sac
- Inflammation of the pericardial sac due to a heart attack
- Radiation therapy to the chest
- Reactions to certain medicines
- Metabolic causes, like an underactive thyroid
In some cases, the cause of constrictive pericarditis is unknown.
If you have severe symptoms, you may need a pericardiectomy. Medicines may help your
symptoms if you have chronic constrictive pericarditis. Surgery may be recommended
when medical therapies are unable to resolve the condition.
In some cases, inflammation can cause a pericardial effusion. This is a buildup of
fluid in the pericardium. This can make it difficult for the heart to beat normally.
You may need a pericardiectomy to drain this fluid and prevent it from coming back.
In most cases, a pericardiectomy is only done if problems with fluid buildup occur
again. A less invasive method is often used for the first time fluid builds up around
What are the risks for pericardiectomy?
All procedures have some risks. The risks of pericardiectomy include:
- Abnormal heart rhythms, which can cause death in rare instances
- Blood clot, which can lead to stroke or other problems
- Complications from anesthesia
- Excess bleeding
- Fluid buildup around the lungs
- Heart attack
- Low cardiac output syndrome
Your own risks may vary according to your age, general health, and the reason for
your procedure. They may also vary depending on the anatomy of the heart, fluid, and
pericardium. Talk with your healthcare provider to find out what risks may apply to
How do I prepare for a pericardiectomy?
Ask your doctor how to prepare for pericardiectomy. You should not eat or drink anything
after midnight before the day of the surgery. Ask the doctor whether you need to stop
taking any medicines before the surgery.
The doctor may want some extra tests before the surgery. These might include:
- Chest X-ray
- ECG or EKG to check the heart rhythm
- Blood tests to assess general health
- Echocardiogram, to view heart anatomy and blood flow through the heart
- CT scan or MRI if the doctor needs more information about the heart
- Heart catheterization to measure the pressures inside the heart
Hair on and around the area of the operation may be removed ahead of time. About an
hour before the operation, you may be given medicines to help you relax.
What happens during a pericardiectomy?
Talk with the doctor about what to expect during the surgery. The details of your
surgery will vary according to the exact kind of repair the doctor is doing. Usually,
doctors do the repair without the use of a heart-lung machine (cardiopulmonary bypass).
During the repair, the team will carefully monitor your vital signs. In general:
- An anesthesiologist will give you general anesthesia before the surgery starts. You
will sleep deeply and painlessly during the operation. You won’t remember it afterwards.
- The surgery will take several hours.
- There are different types of procedures that may be done.
- In some cases, the surgeon will make a vertical incision along the breastbone. This
incision will be several inches long. To access the heart, the surgeon will separate
- The doctor will surgically remove a large portion of the pericardium or the entire
- The doctor will do other repairs to the heart if needed.
- The muscle and the skin incisions will be closed and a bandage will be applied.
What happens after a pericardiectomy?
Ask your doctor about what to expect after the procedure. In general, after your pericardiectomy:
- You may be groggy and disoriented upon waking.
- Your vital signs, such as your heart rate, blood pressure, breathing, and oxygen levels,
will be closely monitored.
- You may have a tube draining the fluid from your chest.
- The drained fluid may be sent to a lab for analysis.
- You may feel some soreness, but you shouldn’t feel severe pain. Pain medicines are
available if needed.
- Your heart symptoms will likely get better very soon after surgery.
- You will probably be able to have liquids the day after surgery. You can have regular
foods as soon as you can handle them.
- You will probably need to stay in the hospital at least several days. This will partially
depend on the reason you needed a pericardiectomy.
After you leave the hospital:
- You will probably have your stitches or staples removed in a follow-up appointment
in 7 to 10 days. Be sure to keep all follow-up appointments.
- You should be able to resume normal activities relatively soon, but you may be a little
more tired for a while after the surgery.
- Ask the doctor if you have any exercise limitations. Avoid heavy lifting.
- Call the doctor if you have fever, increased draining from the wound, increased chest
pain, or any severe symptoms.
- Follow all the instructions your healthcare provider gives you for medicines, exercise,
diet, and wound care.
Before you agree to the test or the procedure make sure you know:
- The name of the test or procedure
- The reason you are having the test or procedure
- What results to expect and what they mean
- The risks and benefits of the test or procedure
- What the possible side effects or complications are
- When and where you are to have the test or procedure
- Who will do the test or procedure and what that person’s qualifications are
- What would happen if you did not have the test or procedure
- Any alternative tests or procedures to think about
- When and how will you get the results
- Who to call after the test or procedure if you have questions or problems
- How much will you have to pay for the test or procedure