The role of pericardiectomy in pericardial disorders

Pericardiectomy today is an accepted therapeutic concept in patients with different pericardial disorders. The postoperative outcome of patients is mainly influenced by two factors. First, diagnosis has to be established early to avoid myocardial deterioration and secondary organ failure, especially of liver and kidneys. Second, the whole accessible surface of atria and ventricles has to be freed from diseased and calcified pericardium. To achieve this, we prefer a total median sternotomy for the surgical approach. In selected cases of acute pericardial effusion or as a palliative procedure, a small infrasternal incision or anterolateral thoracotomy is used for pericardiocentesis and creation of a pericardio-pulmonary window. Between January 1969 and March 1990 we treated 187 patients with different pericardial disorders. Mortality was 4.8% overall, and was especially low (2.8%) among the 106 patients with acute and chronic pericardial effusion. Out of 67 patients with constrictive pericarditis, four died during hospital stay (5.9%). The prognosis is still poor for patients with primary or secondary malignant pericardial tumours, in whom surgery is mostly restricted to palliative resection, and a special group with constrictive and mostly calcified epicarditis, for whom no surgical option is available.