Original Articles
Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage

https://doi.org/10.1016/S0003-4975(98)01192-8Get rights and content

Abstract

Background. Optimal management of cardiac tamponade resulting from pericardial effusion remains controversial.

Methods. Cardiac tamponade in 117 patients was treated with either subxiphoid pericardiostomy (n = 94) or percutaneous catheter drainage (n = 23). Percutaneous catheter drainage was used for patients with hemodynamic instability that precluded subxiphoid pericardiostomy. Effusions were malignant in 75 (64%) of 117 patients and benign in 42 (36%) of 117.

Results. Subxiphoid pericardiostomy had no operative deaths and a complication rate of 1.1% (1 of 94). In contrast, percutaneous drainage had significantly (p < 0.05) higher mortality and complication rates of 4% (1 of 23) and 17% (4 of 23), respectively. Patients with an underlying malignancy had a median survival of 2.2 months, with a 1-year actuarial survival rate of 13.8%. In comparison, patients with benign disease had a median survival of 42.8 months and a 1-, 2-, and 4-year actuarial survival rate of 79%, 73%, and 49%, respectively (p < 0.05). Effusions recurred in 1 (1.1%) of 94 patients after subxiphoid pericardiostomy compared with 7 (30.4%) of 23 patients with percutaneous drainage (p < 0.0001).

Conclusions. Benign and malignant pericardial tamponade can be safely and effectively managed with subxiphoid pericardiostomy. Percutaneous catheter drainage should be reserved for patients with hemodynamic instability.

Section snippets

Patients

From January 1986 to July 1994, 117 patients with clinical and echocardiographic evidence of tamponade underwent either subxiphoid pericardiostomy (n = 94) or percutaneous catheter drainage (n = 23) at Rush-Presbyterian-St. Luke’s Medical Center, Chicago, Illinois. Patients underwent percutaneous drainage if hemodynamic instability precluded operative subxiphoid pericardiostomy. Hemodynamic instability reflected surgical judgment that prompt pericardial drainage was required that would be

Results

Table 2summarizes mortality, morbidity, and effusion recurrence rates associated with subxiphoid pericardiostomy and percutaneous catheter drainage. No deaths were attributed to the subxiphoid pericardiostomy procedure; 1 patient with uremic pericarditis developed a postoperative coagulopathy that required reoperation for bleeding. The overall effusion recurrence rate among patients undergoing subxiphoid pericardiostomy was 1.1% (1 of 94). Effusions recurred in one patient with three separate

Comment

A historical summary regarding the safety and reliability of subxiphoid pericardiostomy for the treatment of pericardial tamponade is shown in Table 3. Combined results from 560 patients demonstrated a mortality rate of 0.6%, a complication rate of 1.5%, and an effusion recurrence rate of 3.2%. Table 4summarizes the results of percutaneous drainage techniques in a similar manner 22, 23, 24, 25, 26, 27, 28. The combined mortality, complication, and effusion recurrence rates in 331 patients were

References (28)

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