Rotational pericardial flap: An alternative tension-free technique for pericardial closure

Abstract

Closing the pericardium in patients with preserved ventricular function has been proposed as a protective measure attempting to minimize the hazards of injuring the myocardium, coronary grafts, and great vessels at the time of reoperation. 1 Despite its own set of advantages, in view of the increasing number of cardiac reoperations, classical pericardial closure has not gained increasing acceptance, mainly because of concerns over its attendant adverse hemodynamic effects. In the interim, using alternative techniques deemed as tension-free pericardial closure or pericardial substitutes has been advocated to benefit patients with safer resternotomy while minimizing the adverse effects on immediate postoperative hemodynamics. Following this line of reasoning, we report an alterna tive technique for tension-free pericardial closure that results in layering the right ventricular free wall and infundibulum by means of a rotational pericardial flap while leaving the great vessels unlayered, thereby minimizing the likelihood of compressive effects on the great vessels and top-end anastomosis.