Pericardiorrhaphy is the surgical repair of wounds to the pericardium (the fibrous sac surrounding the heart) following trauma, injury, or iatrogenic laceration. The name combines ‘pericardio’ (relating to the pericardium) with ‘rrhaphy’ (the surgical suturing or repair of a structure).
The most common indication is penetrating cardiac trauma: wounds caused by stabbing, gunshot injury, or sharp foreign body impalement can lacerate the pericardium and, frequently, the underlying heart muscle. This is a life-threatening emergency because blood rapidly accumulates in the pericardial space, causing cardiac tamponade (compression of the heart that prevents it from filling), and because cardiac lacerations can cause catastrophic haemorrhage leading to cardiac arrest.
Iatrogenic (medically caused) pericardial injuries can occur as complications of cardiac procedures including pacemaker or ICD lead insertion, catheter ablation, and endomyocardial biopsy. These perforations can cause pericardial bleeding requiring urgent pericardiocentesis (needle drainage) or, in severe cases, surgical repair.
In the trauma setting, pericardiorrhaphy is typically performed via emergency thoracotomy, sometimes in the emergency department (resuscitative thoracotomy) for patients in or near cardiac arrest following penetrating chest trauma, or in the operating theatre when the patient is more stable. Pericardiorrhaphy is distinct from pericardiectomy (removal of the pericardium) and pericardiostomy (drainage of the pericardial space).
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