Pericardial Decortication: Is Cardiopulmonary Bypass Required?

Pericardial decortication is a surgical procedure commonly used to treat chronic constrictive pericarditis. This condition involves a chronic inflammatory process that affects both the parietal and visceral layers of the pericardium. Over time, this inflammation leads to fibrosis and thickening of the pericardial tissue, which restricts the heart's ability to expand and contract normally. As a result, the heart becomes encased in a rigid shell, significantly impairing its function.

Understanding the Surgical Approach

During pericardial decortication, the goal is to remove the thickened pericardium to restore normal cardiac function. The procedure can be performed either with or without cardiopulmonary bypass (CPB), depending on the patient's condition and the surgeon's assessment. In many cases, especially when the patient is stable and the anatomy is accessible, the surgery can be performed without stopping the heart. This technique, known as beating-heart surgery, reduces the risks associated with CPB and may lead to faster recovery times.

Preoperative and Postoperative Care

Prior to surgery, patients typically undergo aggressive diuretic therapy to reduce fluid overload and minimize the risk of complications during and after the procedure. During the operation, surgeons carefully dissect the outflow tracts before addressing the inflow areas to ensure optimal exposure and safety.

Following surgery, continued diuretic support is crucial to help the heart gradually adapt to its newly restored mobility. Close monitoring and tailored medical management are essential during the early recovery phase to support cardiac function and prevent fluid accumulation.

When Is Cardiopulmonary Bypass Necessary?

While many patients can safely undergo pericardial decortication without cardiopulmonary bypass, there are situations where it becomes necessary. If significant bleeding occurs and cannot be controlled on a beating heart, the surgical team may opt to use CPB to provide a bloodless field and complete the procedure safely. This decision is made based on intraoperative findings and the patient's hemodynamic stability.

In summary, pericardial decortication can often be performed without stopping the heart, offering a less invasive option for eligible patients. However, the surgical strategy is tailored to each individual case, ensuring both safety and optimal outcomes.