title: Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.
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.
authors: Department of Cardiovascular and Thoracic Surgery, Rush-Presbyterian-St. Lukes Medical Center, Chicago, Illinois, USA.
authors: K B
authors: KB
authors: Allen
authors: L P
authors: LP
authors: Faber
authors: W H
authors: WH
authors: Warren
authors: C J
authors: CJ
authors: Shaar
mesh_terms: 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