Off-pump waffle procedure using an ultrasonic scalpel for constrictive pericarditis

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery

Background:

• Constrictive pericarditis with epicardial constriction poses challenges for surgical treatment.
• Radical pericardiectomy alone may not adequately address severe epicardial constriction.

Purpose of the Study:

• To evaluate the efficacy of a "waffle procedure" combined with radical pericardiectomy for constrictive pericarditis with epicardial constriction.
• To describe the surgical technique, including tips and pitfalls, for performing the waffle procedure without cardiopulmonary bypass.

Main Methods:

• Radical pericardiectomy was performed via median sternotomy using an ultrasonic scalpel and apical suction device.
• A "waffle procedure" involving longitudinal and transverse incisions on the epicardium was applied to the left and then the right ventricle.
• The procedure was successfully completed without the need for cardiopulmonary bypass.

Main Results:

• The "waffle procedure" effectively relieved epicardial constriction in both ventricles.
• A remarkable improvement in the patient's hemodynamic status was observed post-operatively.
• The technique demonstrated feasibility and effectiveness in managing complex constrictive pericarditis.

Conclusions:

• The "waffle procedure" is a highly effective surgical option for constrictive pericarditis with epicardial constriction.
• Performing the "waffle procedure" without cardiopulmonary bypass is feasible and offers significant hemodynamic benefits.
• This surgical approach provides a valuable alternative for patients with severe epicardial constriction.