Transdiaphragmatic pericardiectomy in dogs

Abstract

In patients with recurrent pericardial effusions, pericardiectomy is indicated. The purpose of this study was to describe a transdiaphragmatic approach for subtotal pericardiectomy in dogs and to evaluate its feasibility. In total, 20 canine cadavers weighing less than 10 kg (group S) and 20 weighing more than 20 kg (group L) were used. Within each group, half underwent a subphrenic pericardiectomy via an intercostal approach and half via a transdiaphragmatic approach. For each approach and within each weight group, the percentage of resected pericardium was calculated and compared. Additionally, a case series of nine consecutive client-owned dogs that underwent a transdiaphragmatic pericardiectomy for pericardial effusion was reported. Exposure of pericardium and associated phrenic nerves was excellent in cadavers and clinical patients. In group S, the percentage of resected pericardium was not significantly different between the two approaches. In group L, on the other hand, the percentage of resected pericardium was lower with the transdiaphragmatic approach compared with the intercostal approach (P=0.001). In the clinical patients, no intraoperative complications were encountered and no recurrence of pericardial effusion was seen. Subtotal pericardiectomy via a transdiaphragmatic approach is straightforward and a safe surgical procedure to obtain permanent pericardial drainage in small and large breed dogs.

Feasibility of open‐chest cardiopulmonary resuscitation through a transdiaphragmatic approach in dogs

“…No attempt was made to perform a pericardiotomy in this study because this was beyond the scope of the study objective; however, pericardiotomy may be performed through the diaphragmatic window created during the TD approach. Pericardiotomy has been described for TD pacemaker implantation and TD pericardiectomy in dogs and warrants additional study in conjunction with OCCPR. Aortic cross‐clamping was also not assessed in this study.…”

“…It was successful in the resuscitation of 2 of 5 cases but involved avoiding entry into either the pleural or peritoneal cavities, which may be too technically demanding and time consuming . The TD approach to the thorax is not novel to veterinary medicine and has been described for cardiac pacemaker implantation in small animals . A TD incision has been suggested for OCCPR in cases already undergoing a celiotomy .…”

What is the optimal approach for pericardiectomy in dogs?

“…De Ridder and others (2016) claimed one potential advantage of the transdiaphragmatic technique was increased technical ease; however, they offered no data to substantiate this claim since that was not the main objective of the study. One could argue that reduction in surgical exposure (experienced with a transdiaphragmatic technique) may actually increase the technical demands of the procedure.…”

“…De Ridder and others (2016) suggest that a potential advantage of the transdiaphragmatic approach over the intercostal approach (shown in the image) for pericardiectomy in dogs was increased technical ease; however, could it be argued that the reduction in surgical exposure resulting from the approach may actually increase the procedure's technical demands?…”

“…Regardless of its limits, the study by De Ridder and others (2016) brings to the table a new technique that demands further investigation and comparison to standard methods of pericardiectomy, especially in regard to postoperative discomfort in the clinical environment. Perhaps, combining the pericardial fillet technique with a transdiaphragmatic approach may mitigate some concerns about exposure around the heart base and maximise the surgeon's ability to remove the pericardium.…”