constrictive pericarditis

Hi!
    My husband 54 yr old had constrictive pericariditis 19 yr ago w/pericardectomy @ that time & has had ongoing problems re: to right heart failure. He has chronic renal insufficency and possible liver involvement. Now he is in the hospital with nausea, vomiting, weight loss, and altered mental status, he had an increase ammonia level.. He improved after TPN, lactulose. His fluid status is becoming increasingly difficult to control. He suffers from He is going to have a liver biopsy to assess the liver involvment. The dr. is suggesting a repeat pericardectomy. What are the risks with repeat pericardectomy? When they did his surgey the first time they said he still  had a lot of calcification and they couldn't remove all of it. Are the surgical techniques improved to help remove the calcification/ If he doesn't have surgery are their other options?

[Cleveland Clinic]

Calcificantions make repeat pericardiectomy much more difficult and less successful.  Unfortunately, this is the only option that he has at this point if the disease process is related to constriction.  Sometimes that's difficult to prove.  He should have a cardiac catheterization to look for pressure changes in both lower chambers of the heart to ensure that consitriction is the disease process at stake.  Infrequently, advanced calcifications and inolvement of the ventricular wall may create a restrictive physiology that is very difficult to deal with surgically.  Often times the surgeon won't even consider surgery in such a situation because of high risk.  I am not aware of any new surgical techniques for pericardial disease.