Technical and prognostic outcomes of double-balloon pericardiotomy for large malignancy-related pericardial effusions.
OBJECTIVE
To investigate both the use of immediate or elective double-balloon pericardiotomy (DBP) in patients with a large amount of malignancy-related pericardial effusion, and the prognosis of this subgroup.


METHODS
Observational study after DBP intervention.


METHODS
Tertiary referral center.


METHODS
Fifty patients with malignancy, mainly lung and breast cancer, who were admitted to our critical care unit with a large amount of pericardial effusion. All received echocardiographic-guided pericardiocentesis. Group 1 consisted of 12 patients (24%) who received immediate DBP, and group 2 consisted of 38 patients (76%) who received delayed DBP 2.5 +/- 1.7 days later (mean +/- SD) after emergency pericardiocentesis with pigtail catheter drainage.


METHODS
After the procedure, and at 1 month, 3 months, and 6 months, echocardiography and chest radiography were performed to check for pneumothorax, pericardial effusion reaccumulation, or the appearance of pleural effusion after pigtail catheter removal.


RESULTS
The procedure was successful and without recurrence in 44 patients (88%). Procedural complications were fever in 4 patients (33%) and 10 patients (26%) in group 1 and group 2, respectively (p = 0.72), and mild pneumothorax in 2 patients (17%) and 1 patient (3%) in group 1 and group 2, respectively (p = 0.14). Fifty percent of the patients died within 4 months, while 25% survived to 11 months. High serum calcium, a low albumin/globulin ratio, and positive results on pericardial effusion cytology were poor prognostic factors for long-term survival.


CONCLUSIONS
Both immediate and delayed DBP are a safe and effective method of relieving large pericardial effusions in patients with cancer. Successful DBP without recurrence of pericardial effusion was achieved in 88% of all patients. Survival was related to the extent of the disease.
Wang
Huang-Joe
HJ
Cardiology Section, Department of Internal Medicine, National Taiwan University Hospital, Taipei, Taiwan.
Hsu
Kwan-Lih
KL
Chiang
Fu-Tien
FT
Tseng
Chuen-Den
CD
Tseng
Yung-Zu
YZ
Liau
Chiau-Suong
CS
D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D002404:Catheterization / Q000295:instrumentation*; D003131:Combined Modality Therapy; D004867:Equipment Design; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008175:Lung Neoplasms / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D010166:Palliative Care; D010490:Pericardial Effusion / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D010492:Pericardiectomy / Q000295:instrumentation*; D020519:Pericardiocentesis / Q000295:instrumentation; D012008:Recurrence; D015996:Survival Rate