Pericardial drainage: Subxiphoid vs. transthoracic approach

K. S. Naunheim, K. A. Kesler, A. C. Fiore, M. Turrentine, L. M. Hammell, J. W. Brown, Y. Mohammed, D. G. Pennington

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Abstract

The optimal management of effusive pericardial disease remains controversial. Subxiphoid drainage has been criticized for a high recurrence rate while transthoracic procedures (window or pericardiectomy) are more invasive operations with greater potential for morbidity. We compared subxiphoid (SX group) and transthoracic (TT group) drainage in 131 patients (age range from 1 month to 81 years) treated from 1979 to the present. The etiology of effusion included cancer (38), uremia (24), infection (27), radiation (9), and other (33) causes. The two groups had similar age and sex distribution, etiology, and fluid volume. There was no difference in the operative mortality between the two groups (SX 15%, TT 13%, p = NS). Patients undergoing thoracotomy for treatment of effusive pericardial disease had a higher incidence of respiratory complications as defined by the presence of pneumonia, pleural effusion, prolonged ventilation, and need for reintubation (SX 11%, TT 35%, p < 0.005). This may account, in part, for the longer mean hospital stay in transthoracic group (14.4 vs. 11.4 days). Nine patients were lost to follow-up after hospital discharge. The remaining 104 hospital survivors were followed for between 1 month and 11 years (mean 34 months, cumulative of 297 patient years). Three patients in each group experienced fluid recurrence and all but one were successfully treated by needle aspiration or percutaneous catheter placement. Following discharge, no patient required reoperation for effusive or constrictive pericardial disease or died from tamponade. There were no significant differences in 5-year actuarial survival (SX 54%, TT 49%) or actuarial freedom from recurrence (SX 89%, TT 93%). These data demonstrate that drainage via the subxiphoid approach is as effective as transthoracic procedures in the treatment of pericardial effusion. Although there is no difference in operative mortality, there is a high incidence of respiratory complications in patients treated by transthoracic procedures, probably due to the morbidity of the thoracic incision. This study suggests that the subxiphoid approach may be the technique of choice because of its simplicity, efficacy, and lack of pulmonary compromise.

Original languageEnglish (US)
Pages (from-to)99-104
Number of pages6
JournalEuropean Journal of Cardio-thoracic Surgery
Volume5
Issue number2
DOIs
StatePublished - Feb 1991

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Keywords

  • Pericardial effusion
  • Pericardial window
  • Pericardiectomy
  • Tamponade
  • Thoracotomy

ASJC Scopus subject areas

  • Surgery
  • Cardiology and Cardiovascular Medicine

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