Total pericardiectomy via median sternotomy (Holman and Willett): a video presentation

Abstract

For uniformity with other studies, total pericardiectomy was defined as wide excision of the pericardium with the phrenic nerves defining the posterior extent, the great vessels including the intrapericardial portion of superior vena cava and superior vena cava-right atrial junction defining the superior extent, and the diaphragmatic surface, including the inferior vena cava-right atrial junction defining the inferior extent of the pericardial resection. Radical pericardiectomy was defined as excision of the pericardium as defined under total pericardiectomy including the removal of the pericardium posterior to the phrenic nerve and the diaphragmatic pericardium. Constricting layers of the epicardium were removed whenever possible. The atria and venae cavae were decorticated as a routine. In our previous investigation, we offered cogent and respected reasons for selection of surgical approach in patients undergoing pericardiectomy and demonstrated that total pericardiectomy is associated with lower perioperative and late mortality, less postoperative low cardiac output syndrome, early normalization of hemodynamics and better long-term survival compared with partial pericardiectomy and this is more easily accomplished through median sternotomy [1,2]. We report herein the step-by-step surgical details of total pericardiectomy without utilizing cardiopulmonary bypass via median sternotomy. A 38-year-old man diagnosed with calcific chronic constrictive pericardiectomy in New York Heart Association class IV underwent total pericardiectomy via median sternotomy. The postoperative recovery was uneventful.