Robotic Total Pericardiectomy For Constrictive Pericarditis: Mid-term Results
Caitlin J. Burke, Sarah Nisivaco, Andrea Amabile, Brooke Patel, Husam H. Balkhy
University of Chicago Medicine, Chicago, IL, USA
Objective: Pericardiectomy for chronic constrictive pericarditis can improve symptoms and quality of life. Surgery is commonly performed on CPB via sternotomy and can have high morbidity and mortality. Thoracotomy/VATS confer inadequate visualization and incomplete resection. We hypothesized that robotic-assisted pericardiectomy provides superior exposure/resection and decreased morbidity/mortality. We analyzed outcomes in our patients undergoing robotic-assisted total pericardiectomy.
Methods: Between 10/2013-2/2019, fourteen patients underwent robotic off-pump total pericardiectomy. Constrictive physiology was confirmed by echocardiogram and cardiac catheterization. Surgical approach included: robotic ports in the left 2nd, 4th, and 6th intercostal spaces (anterior axillary line) with a subcostal cardiac stabilizer; resection of posterior pericardium from the left phrenic nerve to IVC, then off the diaphragm to the cardiac apex; dissection anteriorly from left to right phrenic nerve; removal of pericardial remnants via endoscopic bag.
Results: Post-operatively, all patients reported symptomatic relief. Eight patients were male with mean age of 58. Comorbidities included HTN (64.3%), DM (50%), CKD (35.7%), and prior cardiac surgery (14.3%). Average EF was 55%. Median hospital and ICU LOS were 4.5, and 2.0 days, respectively. Average robotic operative time was 262+117 minutes. There were no conversions to open procedures. Three (21.4%) patients required transfusion, 3 required inotrope use, and three underwent additional procedures (1 TECAB and 2 left atrial appendage ligations). Twelve (85.7%) patients were extubated within 24 hours with no re-intubations. There were no perioperative strokes, myocardial infarctions, wound infections, AKI, or take-backs for bleeding. Three (21.4%) patients had atrial fibrillation and one had recurrent left pleural effusion. Thirteen patients were contacted at mean follow-up of 32 months and had no recurrence of constrictive symptoms or repeat surgery. Echocardiography was obtained in 8 patients at mean of 26.4 months and showed normal LV function. 30-day and six-month survival were 100%. Two patients expired 187 and 451 days after surgery from non-cardiac causes.
Conclusions: Robotic total pericardiectomy for constrictive pericarditis is safe and effective. Low perioperative morbidity and mortality with enhanced visualization leading to a more complete resection make a robotic-assisted approach the procedure of choice for constrictive pericarditis in the hands of an experienced team. Further studies are warranted.
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