The surgical indications for pericardiectomy are pericarditis with significant pericardial effusion and tamponade associated with several conditions. The most common types of pericarditis are idiopathic, uremic, infectious, posttraumatic, neoplastic, and chronic constrictive, and patients usually have marked cardiovascular compromise. The primary objective of the operation is to remove as much pericardium as possible to alleviate the altered vascular hemodynamics.

The operation represents significant surgical stress to a patient with an already compromised cardiovascular system. General endotracheal anesthesia is used. The procedure is usually carried out as a closed cardiac operation, except in patients with chronic constrictive pericarditis who have calcium impregnation into the pericardium. In such patients, the procedure should be done as a “pump standby” procedure, with cardiopulmonary bypass available in case of cardiac perforation. A subxiphoid, left anterior thoracotomy, or median sternotomy surgical approach can be used. The approach of choice in all patients except those with chronic constrictive pericarditis is a left anterior thoracotomy. The usual duration of pericardiectomy is 1½ hours; a more extended period is required in patients with chronic constrictive calcific pericarditis. Generally transfusion is unnecessary, although blood should always be available and three or four units may be given if cardiopulmonary bypass is performed.

Usual postoperative course

Expected postoperative hospital stay

From 5 to 7 days, depending on the extent of altered cardiovascular dynamics.

Operative mortality

1% to 5%.

Special monitoring required

Patients receive intensive care for 1 or 2 days, with monitoring of cardiovascular signs, respiratory status, and urinary output.