Urgent surgical repair including cardiac repositioning and pericardial closure resulted in 96.6% survival among patients with postoperative cardiac herniation after thoracic surgery.
Systematic Review (n=29)
Cardiac herniation is a rare but life-threatening complication primarily following right-sided pneumonectomy that requires high clinical suspicion and emergent surgical repair for survival.
Absolute Event Rate: 96.6% vs 3.4%
Cardiac herniation is a rare but potentially fatal complication following thoracic or cardiovascular procedures involving pericardial defects. We systematically reviewed 29 reported cases to evaluate causes, presentations, and outcomes. Most occurred after right intrapericardial pneumonectomy, though mediastinal tumour resections, transplantation, and trauma were also implicated. Clinical features included hypotension, superior vena cava syndrome, and cardiac arrest. Diagnosis was achieved by radiography, computed tomography, or echocardiography. Emergent re-thoracotomy with cardiac repositioning and pericardial repair was essential for survival, while delayed recognition was often fatal. Vigilant monitoring and preventive pericardial reinforcement are recommended.
Kurniawan et al. (Thu,) conducted a systematic review in Patients with surgically induced pericardial defects following thoracic or cardiothoracic surgery leading to postoperative cardiac herniation (n=29). Urgent surgical intervention with re-thoracotomy, manual cardiac repositioning, and definitive pericardial defect closure (direct sutures or patch repair) vs. Delayed or no intervention was evaluated on Survival status after cardiac herniation and intervention. Urgent surgical repair including cardiac repositioning and pericardial closure resulted in 96.6% survival among patients with postoperative cardiac herniation after thoracic surgery.