Thoracoscopic Partial Pericardiectomy in 13 Dogs

Abstract

Thirteen dogs with cardiac tamponade resulting from pericardial effusion were prospectively evaluated to determine feasibility and outcome of thoracoscopic partial pericardiectomy. A lateral thoracoscopic approach allowed adequate exposure to remove a 4- to 5-cm-diameter section of pericardium in all dogs. Complete resolution of cardiac tamponade occurred in all dogs for which there was follow-up (11 dogs). Ten of 13 dogs (76.9%) had neoplastic pericardial effusion. One of these dogs remains alive at 220 days postoperatively and is asymptomatic. The mean survival of the remaining 9 patents with neoplastic effusion was 128 days (range, 14-544 days; median, 38 days). Three of 13 patients (23.1%) had idiopathic pericardial effusion. Two of these dogs remain alive at 585 and 1,250 days postoperatively. One dog with idiopathic pericardial effusion developed cardiomyopathy and was euthanized 18 days after the procedure. Results indicate that the procedure was technically successful in all dogs. No anesthetic complications occurred. Procedural complications included phrenic nerve transection (1 dog), lung laceration (1 dog), and moderate intraoperative bleeding (1 dog). No adverse clinical manifestations of the complications were apparent. We conclude that thoracoscopic partial pericardiectomy is technically feasible and offers several advantages over conventional open thoracic surgical pericardiectomy.

Comparison of acute phase protein and hemodynamic variables in dogs undergoing video-assisted thoracoscopic vs. open pneumonectomy

“…Eliminating conventional abdominal incisions is considered to have a number of potential advantages including faster recovery and thus a shorter hospital stay, decreased postoperative pain, improved postoperative pulmonary function and improved cosmetic outcome. Previous studies have also confirmed the safety and benefits of VATS in thoracic cavity surgery (3,4).…”

“…A number of comparative studies on VATS procedures in animals have evaluated stress parameters and postoperative outcomes (7,8); there have also been studies into the outcomes of VATS lobectomy (4,9). Compared with VATS, hemithorax pneumonectomy is more difficult to perform and there is a higher risk of intra-and post-operative complications occurring (10); thus, the degree of stress and the postoperative hemodynamics in VATS compared with traditional open pneumonectomy remains to be evaluated.…”

Comparison of early stage electrocardiographic, echocardiographic and histopathologic results of partial pericardiectomy and thoracoscopic pericardial window techniques in an animal model

“…disturbance, shock, oliguria and prolonged anesthesia time (Jackson et al, 1999) thoracoscopy is preferred to manage pericardial disease and effusions (Jackson et al, 1999;Palsgaard et al, 2007;Bicer et al, 2015). Considering this and previous postoperative clinical results, comparative investigation of the partial pericardiectomy through thoracotomy and thoracoscopic pericardial window techniques was planned in an experimental animal model.…”

“…P ericardiectomy techniques are performed in both humans and animals to treat neoplastic or non-neoplastic pericardial diseases (Kerstetter et al, 1997;Busch et al, 2015), especially pericardial effusions (Kerstetter et al, 1997;Jackson et al, 1999). The presenting malignant, infectious or idiopathic etiologies may indicate the need for pericardiectomy in small animals (Dupre et al, 2001;Case, 2016).…”

“…The objective of pericardiectomy is to excise sufficient pericardium to excise enough pericardium to eliminate tamponade and to obtain a histologic diagnosis of the patient's condition (Palsgaard et al, 2007;Case, 2016). For this purpose, partial and total pericardiectomy are described, and these techniques are performed via a lateral thoracotomy, median sternotomy or thoracoscopic approach (Hardy et al, 1992;Jackson et al, 1999;Dupre et al, 2001;Palsgaard et al, 2007;Vistarini et al, 2015;Case, 2016). Partial pericardiectomy is a valuable treatment for cases with constrictive pericarditis because echocardiographic symptoms of this constriction (progressive fluid overload, reduced cardiac output and right ventricular pressure disturbance) are only terminated by pericardial surgery (Hardy et al, 1992;Bicer et al, 2015;Busch et al, 2015;Vistarini et al, 2015).…”