Constrictive Pericarditis: Is Open-Heart Surgery Necessary?

Constrictive pericarditis is a condition in which the pericardium — the sac surrounding the heart — becomes thickened, scarred, and rigid. Over time, this restricts the heart's ability to expand properly during filling, impairing normal cardiac function. The definitive treatment for this condition is surgical intervention, typically involving a thoracotomy, or open-chest procedure. This allows surgeons to access and remove the abnormal pericardial tissue that is constricting the heart.

Understanding the Surgical Approach

There are different surgical approaches to treating constrictive pericarditis. The most common method involves a median sternotomy, where the breastbone is split to access the heart. Alternatively, a lateral thoracotomy may be performed, in which an incision is made between the ribs to reach the pericardium. The choice of approach depends on several factors including the extent of pericardial involvement and the surgeon's preference.

What Happens During the Procedure?

During the operation, the surgeon carefully peels away the thickened, fibrotic, or calcified layers of the pericardium that are restricting the heart. This procedure, known as pericardiectomy, aims to fully release the heart from the constrictive sac. Unlike procedures such as coronary artery bypass grafting (CABG) or heart valve replacement, pericardiectomy often does not require the use of cardiopulmonary bypass (heart-lung machine), which reduces the overall risk of the surgery.

Comparing Risks with Other Cardiac Surgeries

While all surgical procedures carry some level of risk, pericardiectomy for constrictive pericarditis is generally considered lower risk than other major cardiac surgeries. In CABG or valve replacement surgeries, the heart is often stopped, and blood flow is rerouted through a bypass machine, increasing the potential for complications. In contrast, pericardiectomy typically allows the heart to continue beating throughout the operation, making the procedure safer for many patients.

Successful removal of the constrictive pericardium allows the heart to resume normal filling patterns, improving blood flow and reducing symptoms such as fatigue, swelling, and shortness of breath. Early diagnosis and timely surgical intervention are key to achieving the best outcomes for patients with constrictive pericarditis.