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Harmonic scalpel for pericardiectomy: novel approach to an old cardiac dilemma
Gabriele Di Luozzo1, Fuad Moussa, John Schor
1Division of Cardiothoracic Surgery, Mount Sinai Medical Center and Jackson Memorial Medical, Center/University of Miami School of Medicine, Miami Beach, Florida 33140, USA.
Insights
The harmonic scalpel offers a safer approach to pericardiectomy, minimizing bleeding and trauma during adhesiolysis. This technique reduces the need for cardiopulmonary bypass and blood transfusions, improving patient outcomes in pericarditis surgery.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Surgical Innovation
Background:
- Pericardiectomy for constrictive or calcific pericarditis presents significant surgical challenges due to dense adhesions.
- Risk of urgent cardiopulmonary bypass, excessive bleeding, and cardiac laceration is high.
- Adhesiolysis requires careful dissection to avoid epicardial damage.
Purpose of the Study:
- To evaluate the safety and efficacy of using a harmonic scalpel for pericardiectomy.
- To assess the impact of harmonic scalpel use on bleeding, need for cardiopulmonary bypass, and mortality.
- To determine if the harmonic scalpel reduces cardiac trauma during adhesiolysis.
Main Methods:
- Retrospective review of 7 pericardiectomies utilizing a handheld harmonic scalpel.
- Analysis of intraoperative and postoperative data, including blood product requirements and need for cardiopulmonary bypass.
- Examination of 30-day mortality and incidence of malignant arrhythmias.
Main Results:
- Zero 30-day mortality in all 7 patients.
- No requirement for blood transfusions or urgent cardiopulmonary bypass due to bleeding.
- No instances of malignant arrhythmias were reported post-procedure.
Conclusions:
- The harmonic scalpel is a safe and effective tool for pericardiectomy.
- It facilitates a bloodless operative field, making adhesiolysis less hazardous.
- The technique is not associated with increased arrhythmogenic risk.
Background:
Pericardiectomy for constrictive or calcific pericarditis is a technical challenge because of dense adhesions to the epicardial surface of the heart. The procedure is fraught with the possibility of urgent cardiopulmonary bypass from excessive bleeding or cardiac laceration. We propose the use of a harmonic scalpel to perform adhesiolysis with less bleeding and cardiac trauma.
Methods And Materials:
A retrospective review of 7 pericardiectomies performed with a handheld harmonic scalpel over the past 2 years was performed. Requirements for blood products, the need for cardiopulmonary bypass, and mortality were examined.
Results:
Four of the patients underwent pericardiectomy alone, and 3 patients underwent pericardiectomy with additional cardiac procedures. The 30-day mortality was zero. No patient needed blood transfusions or urgent cardiopulmonary bypass for bleeding. No patient developed malignant arrhythmias.
Conclusions:
Use of a harmonic scalpel is a safe and efficient technique for pericardiectomy. Adhesiolysis is less treacherous because of the bloodless operative field; moreover, the harmonic scalpel is not arrhythmogenic.
