Pericardiectomy

A pericardiectomy is a surgical procedure that removes part or all of the pericardium. The pericardium is the double layer of tissue that surrounds the heart. There are several different conditions that can be treated with this procedure, including one of the rarest types of mesothelioma, pericardial mesothelioma. For mesothelioma patients, this surgery may relieve symptoms and extend life expectancy.

Pericardial mesothelioma is rare and a pericardiectomy is more often performed to treat inflammation or fibrosis of the pericardium, regardless of the underlying cause. It may also be used to treat pericardial effusion, the buildup of fluid in the pericardium. All of these conditions can have a serious impact on the heart and if not treated can lead to heart failure and death. Pericardiectomy can be risky and cause complications, but the risks of not performing it are often higher.

What Is a Pericardiectomy?

The pericardium is part of the mesothelium, the double-layered tissue that protects and surrounds most of the body’s organs and lines the chest cavity and abdominal cavity. When there is some type of disease affecting this tissue, it may become inflamed, filled with fluid, or it may harden. All of these cause uncomfortable symptoms, and in the case of the pericardium, cause real damage to the heart. A pericardiectomy is used to remove this tissue that has become diseased and to relieve symptoms and prevent more harm. During a pericardiectomy the surgeon may remove only diseased portions of the pericardium, or all of it.

What Pericardiectomy Treats

The surgery to remove the pericardium is done to treat serious conditions that are causing difficult symptoms. One of the most common conditions treated with this procedure is called constrictive pericarditis. This is characterized by inflammation of the pericardium followed by stiffness and rigidity that constricts the heart. This is not only uncomfortable, but harmful and fatal if not treated. Heart surgery and chest radiation are common causes of constrictive pericarditis, but it may also be caused by infections and mesothelioma, both pleural and pericardial mesothelioma.

The Procedure

There are different ways that a pericardiectomy can be performed, but the typical way is through a median sternotomy. This means that the surgeon makes an incision in the sternum, or breastbone, to access the pericardium around the heart. The surgeon then makes cuts to remove the disease tissue, wires the breastbone back together and closes the incision with stitches.

Recovery

A pericardiectomy is a major surgery that requires general anesthesia, but recovery is not as long or as slow as it may be for other surgeries used to treat mesothelioma. Most patients undergoing this procedure will spend between five days and a week in the hospital to be monitored for complications, to make sure fluid gets drained from the chest cavity and around the heart, and to allow for rest and recovery.

Once back at home most patients will be nearly fully recovered. Lifting may be restricted, but other normal activities are usually allowed. This varies by patients and each individual’s surgeon and doctor will make that decision. Patients who have more advanced disease, such as late stage mesothelioma, or who are in poorer health in general, may not recover from this surgery fully for two months or more.

Risks and Complications

With any surgery there are risks, especially when the surgery is related to the heart. A pericardiectomy is a serious procedure that is only performed by experts in thoracic surgery. Possible complications of which patients should be aware include complications from the anesthesia, bleeding, blood clots, abnormal heart rhythms, a buildup of fluid in the chest cavity and around the lungs, pneumonia and other infections, and even death.

The risks associated with this procedure vary depending on the individual patients. Those with other health issues, with compromised immune systems, or who are older may be at a greater risk for experiencing complications. If you are facing the choice of undergoing a pericardiectomy, talk with your doctor and the surgeon about your risks so you can weigh them against the benefits and make an informed decision. For most people experiencing the side effects of a diseased pericardium, the risks are well worth the benefits of having it removed.

Benefits of a Pericardiectomy for Mesothelioma Patients

Mesothelioma patients most often undergo a pericardiectomy to relieve symptoms. Both pleural and pericardial mesothelioma may cause damage to the pericardium. This type of cancer can cause constrictive pericarditis, pericardial effusion, and tumors in the pericardium. All of these things can cause serious symptoms, such as swelling, fatigue, chest pains, and difficulty breathing.

For mesothelioma patients experiencing pericardial effusion, the buildup of fluid in the pericardium, a less invasive procedure is usually used first. A pericardiocentesis uses a needle to drain the fluid. However, if the fluid keeps coming back, the patient may need a pericardiectomy to prevent the recurrence and to provide more lasting relief.

Another benefit that mesothelioma patients may get from undergoing a pericardiectomy is to extend life expectancy. If the patient has pericardial mesothelioma or pleural mesothelioma that has spread to the pericardium, removing the tissue with the tumors can slow the spread of the cancer to the rest of the body. This in turn may extend the patient’s life expectancy. For some patients, in the later stages of the disease, this may not be possible and the procedure may be only palliative. But, for those in the earlier stages of cancer, the pericardiectomy may extend life by months or even years.

Pericardiectomy is one of many possible surgical procedures and treatments that may be used for patients living with mesothelioma. The pericardium of the heart is affected in patients with both the pleural and pericardial form of the cancer and addressing treatment of this tissue around the heart is important. For most mesothelioma patients the surgery risks are worth the benefits of getting relief from debilitating symptoms. Being able to breathe better and having less pain add to the quality of life for a patient with this disease. For some it can even add to their life expectancies. If you are facing this procedure, be sure to have all your questions answered so you feel comfortable going ahead with it.