25 A Toolkit for Health Care Professionals Recurrent Pericarditis Surgery for Refractory Disease Radical surgical pericardiectomy should be considered as potential definitive therapy in patients with refractory symptoms, or where long-term medical therapy (including IL-1 receptor blockade) cannot be withdrawn or is contraindicated. Such surgery should be performed at the hands of experienced pericardial surgeons at expert pericardial centers. Performance of a traditional complete pericardiectomy, removing the anterior and inferior pericardium alone, is insufficient for the treatment of recurrent pericarditis. Complete or near-total removal of the pericardium is essential, including removal of posterior pericardium along the left ventricular lateral wall. Surgery may necessitate the use of cardiopulmonary bypass to decompress the heart to allow adequate access for pericardial resection. In contrast to those patients with constrictive pericarditis, radical surgical pericardiectomy for recurrent pericarditis is associated with low mortality and morbidity. In a study from Mayo Clinic: • Radical pericardiectomy for recurrent pericarditis was associated with no perioperative mortality and a 3% incidence of major postoperative complications, including one early reoperation for postoperative bleeding and one CVA.84 • At a mean follow-up of 5.5 years, surgical pericardiectomy was associated with 91.4% freedom from recurrence as compared with 71.4% in the medical treatment group.1 • Pericardiectomy was associated with improvement in symptoms and fewer relapses as compared with those who did not undergo pericardiectomy.84 Notes:
RkJQdWJsaXNoZXIy MjI2NjI=