Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.
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.
Allen
K B
KB
Department of Cardiovascular and Thoracic Surgery, Rush-Presbyterian-St. Lukes Medical Center, Chicago, Illinois, USA.
Faber
L P
LP
Warren
W H
WH
Shaar
C J
CJ
D002305:Cardiac Tamponade / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D002408:Catheters, Indwelling; D004322:Drainage / Q000295:instrumentation*; D006801:Humans; D010490:Pericardial Effusion / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010492:Pericardiectomy / Q000295:instrumentation*; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D015996:Survival Rate; D016896:Treatment Outcome