title: Harmonic scalpel for pericardiectomy: novel approach to an old cardiac dilemma.
abstract: BACKGROUND
  Pericardiectomy for constrictive or calcific pericarditis is a technical challenge because of dense adhesions to the epicardial surface of the heart. The procedure is fraught with the possibility of urgent cardiopulmonary bypass from excessive bleeding or cardiac laceration. We propose the use of a harmonic scalpel to perform adhesiolysis with less bleeding and cardiac trauma.
  
  
  METHODS
  A retrospective review of 7 pericardiectomies performed with a handheld harmonic scalpel over the past 2 years was performed. Requirements for blood products, the need for cardiopulmonary bypass, and mortality were examined.
  
  
  RESULTS
  Four of the patients underwent pericardiectomy alone, and 3 patients underwent pericardiectomy with additional cardiac procedures. The 30-day mortality was zero. No patient needed blood transfusions or urgent cardiopulmonary bypass for bleeding. No patient developed malignant arrhythmias.
  
  
  CONCLUSIONS
  Use of a harmonic scalpel is a safe and efficient technique for pericardiectomy. Adhesiolysis is less treacherous because of the bloodless operative field; moreover, the harmonic scalpel is not arrhythmogenic.
authors.affiliation: Division of Cardiothoracic Surgery, Mount Sinai Medical Center and Jackson Memorial Medical, Center/University of Miami School of Medicine, Miami Beach, Florida 33140, USA.
authors.forename: Gabriele
authors.initials: G
authors.lastname: Di Luozzo
authors.forename: Fuad
authors.initials: F
authors.lastname: Moussa
authors.forename: John
authors.initials: J
authors.lastname: Schor
authors.forename: Ernest
authors.initials: E
authors.lastname: Traad
authors.forename: Donald
authors.initials: D
authors.lastname: Williams
authors.forename: Roger
authors.initials: R
authors.lastname: Carrillo
mesh_terms: D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000295:instrumentation* / Q000379:methods; D004867:Equipment Design; D019544:Equipment Failure Analysis; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010493:Pericarditis / Q000628:therapy*; D012189:Retrospective Studies; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation* / Q000379:methods