Harmonic Scalpel for Pericardiectomy: Novel Approach to an Old Cardiac Dilemma
DOI:
https://doi.org/10.1532/HSF98.20041091Abstract
Background: Pericardiectomy for constrictive or calcific pericarditis is a technical challenge because of dense adhesions to the epicardial surface of the heart. The procedure is fraught with the possibility of urgent cardiopulmonary bypass from excessive bleeding or cardiac laceration. We propose the use of a harmonic scalpel to perform adhesiolysis with less bleeding and cardiac trauma.
Methods and Materials: A retrospective review of 7 pericardiectomies performed with a handheld harmonic scalpel over the past 2 years was performed. Requirements for blood products, the need for cardiopulmonary bypass, and mortality were examined.
Results: Four of the patients underwent pericardiectomy alone, and 3 patients underwent pericardiectomy with additional cardiac procedures. The 30-day mortality was zero. No patient needed blood transfusions or urgent cardiopulmonary bypass for bleeding. No patient developed malignant arrhythmias.
Conclusions: Use of a harmonic scalpel is a safe and efficient technique for pericardiectomy. Adhesiolysis is less treacherous because of the bloodless operative field; moreover, the harmonic scalpel is not arrhythmogenic.
References
de Chaumaray TD, Menasche P. 1995. Ultrasonic dissection: a useful adjunct to operation for calcified constrictive pericarditis. Ann Thoracic Surg 59:1243-4.nGosh P. 1999. Ultrasonic devices in cardiac surgery. Asian Cardiovasc Thorac Ann 7:333-8.nLing LH, Oh JK, Schaff HV, et al. 1999. Constrictive pericarditis in the modern era: evolving clinical spectrum and impact on outcome after pericardectomy. Circulation 100:1380-6.nUchida T, Bando K, Minatoya K, Sasako Y, Kobayashi J, Kitamura S. 2001. Pericardectomy for constrictive pericarditis using the harmonic scalpel. Ann Thoracic Surg 72:924-5.n
