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 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? Can you explain how they remove the calcification?

[Cleveland Clinic]

Removal of calcifications is very difficult especially if RV involvement is present.  that puts the patient at high risk for bleeding because the RV wall is very thin.  Like I stated earlier, some surgeon will not even offer this surgery if they feel that the calcifications are very extensive making the risk of the operation high and the likelihood of improvement after surgery low.