Pericardiectomy using an ultrasonic scalpel in patients with constrictive pericarditis

Abstract OBJECTIVES Pericardiectomy using an ultrasonic scalpel is the effective operative treatment of chronic pericarditis. However, no consecutive case series of radical pericardiectomy using an ultrasonic scalpel has been reported. METHODS We retrospectively reviewed the records of 10 patients who underwent a radical pericardiectomy with an ultrasonic scalpel between April 2015 and March 2024. Preoperative and postoperative variables were reviewed. RESULTS The median age was 65 years, and 3 patients were female. Three patients had preoperative atrial fibrillation. Forty percent of patients were in NYHA class 3–4. Three patients underwent urgent operations. An ultrasonic scalpel was used for the dissection and resection of thickened parietal pericardium and visceral pericardium around the heart except in the area of the posterior left atrium in all patients. Three patients underwent the off-pump technique. Coronary artery bypass grafting and tricuspid valve annuloplasty were performed concomitantly in 3 and 1 patients, respectively. There were no operative deaths. Mediastinitis and acute kidney injury were observed in 1 patient each. One patient died of a stroke during the follow-up period. The other patients were in NYHA class I. CONCLUSIONS Radical pericardiectomy is essential in patients with constrictive pericarditis. An ultrasonic scalpel is a useful tool with which to perform a radical resection of pericardium.