Original ArticlesPericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage
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
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2018, Clinical Lung CancerCitation Excerpt :While cardiac tamponade can be treated with pericardiocentesis emergently, recurrent effusions need a surgical pericardial window, with most malignant effusions responding well.4 It is clear that pericardiocentesis is associated with a greater likelihood of recurrence, ranging from 13.9% to 60% in some series,11,12 while subxiphoid and pleuropericardial windows have recurrence rates below 10% and 15%, respectively.4 Our patient needed 4 interventions despite adequately fashioned windows, usually smaller, at 4.0 × 4.0 cm.13-15