Expert Opinions on the Debate of Pericardial Reconstruction in Cardiovascular Surgery: To Close or Not to Close?


  • Alfredo Rego, MD, PhD Jackson Heart Institute, Department of Cardiothoracic Surgery, Jackson Health System, Miami, Florida
  • W. Douglas Boyd, MD Division of Cardiothoracic Surgery, Department of Cardiovascular Sciences, Brody School of Medicine, East Carolina University, Greenville, North Carolina
  • Enrique Gongora, MD Division of Cardiothoracic Surgery, Department of Surgery, University of Alabama at Birmingham School of Medicine, Birmingham, Alabama
  • William E. Johnson 3rd, MD Infirmary Health, Cardio-Thoracic and Vascular Surgical Associates, Mobile, Alabama
  • Nabil A. Munfakh, MD Division of Cardiothoracic Surgery, Department of Surgery, Washington University School of Medicine in St. Louis, St. Louis, Missouri
  • John Pirris, MD Division of Cardiothoracic Surgery, Department of Surgery, University of Florida College of Medicine, Jacksonville, Florida
  • Randall K. Wolf, MD DeBakey Heart and Vascular Center, Houston Methodist Hospital, Texas Medical Center, Houston, Texas



adhesions; CorMatrix; expert consensus; expert opinion; extracellular matrix; pericardial closure; pericardial patch; pericardial reconstruction; postoperative atrial fibrillation; ProxiCor.


Background: As of 2019, pericardial closure was performed in only a small portion of the over 320,000 cardiac surgeries performed annually. However, evidence regarding the benefits of pericardial closure or reconstruction has been accruing, particularly with the publication of the RECON study in 2019.

 Methods: This group of authors convened to try to arrive at consensus expert opinion regarding pericardial reconstruction. Structured topic questions initially were used to stimulate discussion. Subsequently, a survey of proposed expert opinion statements was conducted among the authors. Based on that survey, consensus expert opinion statements and recommendations were compiled.

Results: The expert opinions encompass various topics relating to pericardial reconstruction, including definitions, benefits/risks, and technique. Observed benefits include reductions in: (1) adhesions; (2) postoperative pericardial effusion, atrial fibrillation, and bleeding; and (3) readmissions and length of hospital stay. Expert opinion recommendations regarding surgical technique are compiled into a single chart. Complete pericardial reconstruction should be performed, using native pericardial tissue if available and viable; if not feasible, a patch may be used. Patches that stimulate the formation of site-specific tissue in situ (such as natural extracellular matrix) may have additional benefits (including bioregenerative properties and lack of inflammatory response). Closure should be taut, but tension-free. Adequate drainage of the closed pericardium must be ensured.

Conclusions: Based on available data and collective surgical experience, we endorse pericardial reconstruction as standard approach in appropriately selected patients. We also endorse adoption of standardized pericardial reconstruction techniques to optimize patient outcomes and improve evidence quality in future studies.


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How to Cite

Rego, A., Boyd, W. D., Gongora, E., Johnson, III, W. E. ., Munfakh, N. A., Pirris, J., & Wolf, R. K. (2022). Expert Opinions on the Debate of Pericardial Reconstruction in Cardiovascular Surgery: To Close or Not to Close?. The Heart Surgery Forum, 25(1), E008-E019.