Volume: 8 Issue: 1
Year: 2020, Page: 81-85,
Introduction: Whether pericardial closure should be done or not is still a debated topic. While many studies favour pericardial closure after cardiac surgery, many are still not in favour of the same.
Objective: Objective of this study was to analyse the changes induced by pericardial closure on the haemodynamic of the patient using easily measurable variables.
Methods: Data of 30 patients were analysed of which 14 underwent mitral valve replacement, 10 underwent coronary artery bypass grafting and 6 underwent double valve replacement.
Results: There was statistically significant change in cardiac output (p<0.01), central venous pressure (p<0.05) and left ventricular end diastolic diameter (p<0.01) after pericardial closure. Clinically the pericardial closure was well tolerated.
Conclusion: Despite exhaustive experience, the topic of closing pericardium is still debated. Our study shows that clinically pericardial closure is well tolerated and in return it also safeguards the risks associated with re-do operations.
Keywords: Pericardial closure, Cardiac output, Left ventricular end diastolic diameter, Central venous pressure
1. Gibbon JH. Surgery of the chest. Philadelphia:WBSaunders;1969. p.143.
2. Nandi P, Leung JS, Cheung KL. Closure of pericardium after open heart surgery. A way to prevent postoperative cardiac tamponade. Br Heart J. 1976;38(12):1319-23.
3. Asanza L, Rao G, Voleti C, Hartstein ML, Wisoff BG. Should the pericardium be closed after an open-heart operation? Ann Thorac Surg. 1976;22(6):532-4.
4. Bahn CH, Annest LS, Miyamoto M. Pericardial closure. Ann J Surg. 1986;151(5):612-5.
5. Christakis GT, Ivanov J, Weisel RD, Birnbaum PL, David TE, Salerno TA. The changing pattern of coronary artery bypass surgery. Circulation. 1989;80(3 Pt 1):I151- 61.
6. Macmanus Q, Okies JE, Phillips SJ, Starr A. Surgical considerations in patients undergoing repeat median sternotomy. J Thorac Cardiovasc Surg. 1975;69(1):138-43.
7. Loop FD. Catastrophic hemorrhage during sternal reentry. Ann Thorac Surg. 1984;37(4):271-2.
8. Dobell AR, Jain AK. Catastrophic hemorrhage during redo sternotomy. Ann Thorac Surg. 1984;37(4):273-8.
9. Cunningham Jr JN, Spencer FC, Zeff R, Williams CD, Cukingham R, Mullin M. lnfluence of primary closure of the pericardium after open-heart surgery on the frequence of tamponade, postpericardiotomy syndrome, and pulmonary complications. J Thorac Cardiovasc Surg 1975; 70: 119-125.
10. Frist WH, Daughters GT, Mead CW, Derby GC, Schwarzkopf A, Miller DC. Pericardial closure adversely affects early 1985;72(Suppl 3):1301
11. Daughters GT, Mcad CW, Alderman EL, Derby GC, Schwarzkopf A, Miller DC. Effects of the pericardium on LV diastolic filling in man early after cardiac surgery [Abstract]. Circulation 1985;72(Suppl 3):411
12. Jarvinen A, Peltola K, Rasanen J, Heikkila J. Immediate haemodynamic effects of pericardial closure after open heart surgery. Scand J Thorac Cardiovasc Surg 1987;21:1314.
13. Damen J, Bolton DT. Acute haemodynamic effects of pericardial closure in man. Acta Anaesthesiol S c a d 1989;33:207-9.
14. Rao V, Komeda M, Weisel RD, Cohen G, Borger MA, David TE. Should the pericardium be closed routinely after heart operations? Ann. Thorac. Surg. 67(2), 484–488 (1999).
15. Daughters GT, Frist WH, Alderman EL, Derby GC, Ingels NB Jr, Miller DC. Effects of the pericardium on left ventricular diastolic filling and systolic performance early after cardiac operations. J. Thorac. Cardiovasc. Surg. 104(4), 1084–1091 (1992).
16. Hunter S, Smith GH, Angelini GD. Adverse hemodynamic effects of pericardial closure soon after open heart operation. Ann. Thorac. Surg. 53(3), 425–429 (1992).
17. Bittar MN, Barnard JB, Khasati N, Richardson S. Should the pericardium be closed in patients undergoing cardiac surgery? Interact. Cardiovasc. Thorac. Surg. 4(2), 151– 155 (2005).
18. Raja SG. Comment to: should the pericardium be closed in patients undergoing cardiac surgery? Interact Cardiovasc. Thorac. Surg. 4(2), 155 (2005).
19. Kroeker CA, Shrive NG, Belenkie I, Tyberg JV. Pericardium modulates left and right ventricular stroke volumes to compensate for sudden changes in atrial volume. Am. J. Physiol. Heart Circ. Physiol. 284(6), H2247–H2254 (2003).
20. Bhatnagar G, Fremes SE, Christakis GT, Goldman BS. Early results using an ePTFE membrane for pericardial closure following coronary bypass grafting. J. Card. Surg.13(3), 190–193 (1998).
21. Li JY, Chen YS, Wu SJ, Hu PY. Modified pericardial closure to protect internal mammary artery grafts in coronary artery bypass. Thorac. Cardiovasc. Surg. 50(3), 182–183 (2002)
22. Zapolanski A, Fishman NH, Bronstein MN, Ellertson DG, O’Connell TJ, Siegel S. Modified pericardial closure to protect cardiovascular structures during sternal reentry. Ann. Thorac. Surg. 50(4), 665–666 (1990)
23. Shirato K, Kanazawa M, Ishikawa K, Nakajima T, Takishima T. The effect of pericardium on the diastolic properties of the heart. Experimental studies on volume load and on acute ischemia in open chest dogs. Jap Circ J 1982; 46: 113-123
24. Spodick DH. The Pericardium: A Comprehensive Textbook. Marcel Dekker,NY, USA, 387 (1997).
25. Elahi M, Dhannapuneni R, Firmin R, Hickey M. Direct complications of repeat median sternotomy in adults. Asian Cardiovasc. Thorac. Ann. 13(2), 135–138 (2005).
26. Lahtinen J, Satta J, Lähde S et al. Computed tomographic evaluation of retrosternal adhesions after pericardial substitution. Ann. Thorac. Surg. 66(4), 1264–1268 (1998).
27. Anselmi A, Possati G, Gaudino M. Postoperative inflammatory reaction and atrial fibrillation: simple correlation or causation? Ann. Thorac. Surg. 88(1),326– 333 (2009).
28. Boos CJ, Anderson RA, Lip GY. Is atrial fibrillation an inflammatory disorder? Eur. Heart J. 27(2), 136–149 (2006)
29. Tselentakis EV, Woodford E, Chandy J, Gaudette GR, Saltman AE. Inflammation effects on the electrical properties of atrial tissue and inducibility of postoperative atrial fibrillation. J. Surg. Res. 135(1), 68–75 (2006).
Saurabh KS, Padhy AK, Kumar M, Munjal R, Gupta A Haemodynamic Effects of Pericardial Closure after Cardiac Surgery. Perspectives in Medical Research 2020; 8(1):81-85