Pericardiectomy
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A pericardiectomy is a surgical procedure that removes part or all of the pericardium, the double layer of tissue surrounding the heart. It is used to treat pericardial mesothelioma, relieve symptoms, and extend life expectancy. The procedure is risky, with a high potential for complications.
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. This double-layered tissue also lines the chest and abdominal cavities. When disease affects this tissue, it may become inflamed, filled with fluid, or harden.
All of these cause uncomfortable symptoms, but they also cause real damage to the heart. A pericardiectomy removes diseased tissue to relieve symptoms and prevent further damage. During a pericardiectomy, the surgeon may remove only diseased portions of the pericardium, or they may remove all of it.[1]
What Pericardiectomy Treats
Pericardiectomy surgery treats serious conditions that cause difficult symptoms. One of the most common conditions is constrictive pericarditis.[1] Constrictive pericarditis is characterized by inflammation of the pericardium followed by stiffness and rigidity that constricts the heart.
This condition is uncomfortable but can also be fatal. Heart surgery and chest radiation are common causes of constrictive pericarditis, but it can also be caused by infections and both pleural and pericardial mesothelioma.[2]
The Procedure
There are different ways to perform a pericardiectomy; however, the typical way is through a median sternotomy. This means the surgeon makes an incision in the sternum to access the pericardium around the heart.
The surgeon then cuts out the diseased tissue, wires the breastbone back together, and closes the incision with stitches.[3] Alternatively, if a patient is undergoing VATS or thoracoscopic surgery for another reason, the surgeon may be able to perform a pericardiectomy at the same time.
Recovery from Pericardiectomy
A pericardiectomy is a major surgery that requires general anesthesia. Recovery can be difficult but is not as long as other surgeries used to treat mesothelioma. Most patients will spend between five to seven days in the hospital.
Staff monitor patients for complications during the stay. They may also drain fluid from the chest cavity and surrounding area.
Once a patient is released from the hospital, they will be nearly fully recovered. Lifting may be restricted, but other normal activities are usually allowed.
Limitations vary by patient. Patients in poor general health or with more advanced diseases, such as late-stage mesothelioma, may not fully recover for two months or more.
Risks and Complications
With any surgery, there are risks. This is particularly true when the surgery is related to the heart. A pericardiectomy is a serious procedure only performed by experts in thoracic surgery. Possible complications include:
- Complications from anesthesia
- Bleeding
- Blood clots
- Abnormal heart rhythms
- Buildup of fluid in the chest cavity and around the lungs
- Infection
The risks associated with this procedure vary depending on the individual patient. Those with other health issues or with compromised immune systems may be at a greater risk for complications.
If you are facing the choice of a pericardiectomy, talk with your doctor about your risks. You will need to weigh these risks against the benefits to make a fully informed decision. For most people with a diseased pericardium, the risks are worth the benefits of having it removed.
Benefits of a Pericardiectomy for Mesothelioma Patients
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. These can cause serious symptoms like swelling, fatigue, chest pain, and difficulty breathing. Mesothelioma patients often receive a pericardiectomy to relieve symptoms.
For mesothelioma patients experiencing pericardial effusion, a less invasive procedure is usually used first. A pericardiocentesis uses a needle to drain fluid buildup. However, if the fluid continues to accumulate, the patient may need a pericardiectomy to prevent recurrence and provide lasting relief.
Another benefit of a pericardiectomy for mesothelioma patients is improving life expectancy. If the patient has early-stage pericardial mesothelioma, removing the tissue can slow the spread of cancer to the rest of the body. This could extend the patient’s life expectancy.
For some patients in the later stages of the disease, the procedure may only be palliative.[4] However, the pericardiectomy may extend life by months or even years for those in the earlier stages of cancer.
Pericardiectomy is one of many surgical procedures and treatments used for patients living with mesothelioma. The pericardium of the heart is affected in patients with both pleural and pericardial forms of mesothelioma. For most mesothelioma patients, the surgery’s risks are worth the potential benefits of the procedure.
The ability to breathe and reduce pain levels adds to the quality of life for a patient with this disease. For some, pericardiectomy can even add to their life expectancy. If you are facing this procedure, be sure to ask questions and seek information so you can feel comfortable with moving ahead with treatment.
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Anne Courtney has a Doctor of Nursing Practice degree and is an Advanced Oncology Certified Nurse Practitioner. She has years of oncology experience working with patients with malignant mesothelioma, as well as other types of cancer. Dr. Courtney currently works at University of Texas LIVESTRONG Cancer Institutes.