“What About Adhesions, Pericardium Closing and Heart Valve Reoperations?” Asks Judy
I just received an interesting email from Judy about adhesions, the pericardium and heart valve re-operations.
Judy writes, “Hi Adam, I am a 66-year old female preparing for aortic valve replacement. I have calcification at the sinotubular junction. Reoperation would be tricky in my case as I have an anomalous circumflex artery. I wondered what can be done to minimize the chances of adhesions? Could not closing the pericardium contribute to adhesions? What are the pros and cons of leaving the pericardium open? Thanks, Judy”
To answer Judy’s questions, I contacted Dr. Craig Smith, the chairman of surgery at NewYork-Presbyterian Hospital / Columbia University Medical Center. If you did not know, Dr. Smith recently performed aortic valve replacement on Barbara Walters. Doctor Smith has also operated on Former President Bill Clinton and several members of our patient community including Gary Poltorak.
Dr. Craig Smith – Heart Surgeon of Former President Bill Clinton
and Barbara Walters (NewYork-Presbyterian Hospital)
In his response to Judy, Dr. Smith noted…
Calcification of the sinotubular junction is very common, and usually unimportant, although it’s a matter of degree, and occasionally requires partial removal at the time of surgery. An anomalous circumflex rarely has anything to do with the conduct of the first or subsequent operations; I’m curious why you were told this.
As for questions about adhesions, Dr. Smith noted:
Adhesions can’t be prevented. Various things have been tried over the years to minimize adhesions, none convincingly beneficial. It is unclear on the basis of real evidence whether closing the pericardium minimizes adhesions, although many believe it makes re-entry somewhat easier. The latest thing, which might prove beneficial, is to close the pericardium with a substance called CorMatrix.
If you are unfamiliar with the term… Adhesions are a form of scar tissue. Scar tissue may form within the membranes that surround the heart (pericardial sac) after surgery and potentially restrict heart function. The diagram below illustrates the use of CorMatrix during surgery.
Specific to Judy’s last question about reoperations, Dr. Smith shared:
Personally, I don’t find reoperations greatly different with open or closed pericardium. Most reoperations are relatively routine and low risk, though certainly not all. We don’t know yet whether reoperating after placement of CorMatrix will make a clear difference.
I hope this helped all of us learn more about adhesions, pericardium closing and reoperations. Thanks to Judy for her question and thanks to Dr. Craig Smith for his clinical insight. If you are interested to learn more about Dr. Craig Smith, please click here.
Keep on tickin!
Adam Pick is a patient, author of The Patient's Guide To Heart Valve Surgery and the founder of HeartValveSurgery.com.