Subxiphoid pericardiostomy in the management of pericardial effusions: case series analysis of 368 patients.
OBJECTIVE
To assess the effectiveness of subxiphoid pericardiostomy in the treatment and diagnosis of pericardial effusions.


METHODS
368 patients who underwent subxiphoid pericardiostomy and tube drainage for cardiac tamponade, moderate to severe pericardial effusion, or suspicious bacterial aetiology were retrospectively analysed. Biopsies of the pericardium and fluid samples for diagnostic tests were obtained from each patient.


RESULTS
The mean age of the patients was 38.4 years, and the male to female ratio was 220:148. The pericardial effusion was classified by echocardiography as severe in 53% of the patients, moderate in 43%, and mild in 4%. The incidence of cardiac tamponade was 25%. Myocardial injury requiring sternotomy occurred as an operative complication in 0.8% of the patients and recurrent effusion necessitating further surgical intervention developed in 10% of patients. Histopathological examination and the polymerase chain reaction of specimens of pericardium and fluid were helpful for establishing a diagnosis in 90% of patients with malignancy and 92% of patients with tuberculous pericarditis. The overall 30 day mortality rate was 0.8%. Patients were followed up for at least one year. Pericardial constriction requiring pericardiectomy developed in 3% of the patients.


CONCLUSIONS
Pericardial effusions of various causes can be safely, effectively, and quickly managed with subxiphoid pericardiostomy in both adults and children.
Becit
N
N
Department of Cardiovascular Surgery, Atatürk University School of Medicine, Erzurum, Turkey. necipbecit@hotmail.com
Unlü
Y
Y
Ceviz
M
M
Koçogullari
C U
CU
Koçak
H
H
Gürlertop
Y
Y
D000293:Adolescent; D000328:Adult; D000368:Aged; D002305:Cardiac Tamponade / Q000209:etiology / Q000601:surgery; D002648:Child; D002675:Child, Preschool; D005260:Female; D006335:Heart Injuries / Q000209:etiology; D006801:Humans; D007431:Intraoperative Complications / Q000209:etiology; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D010491:Pericardial Window Techniques