title: Comparative study of subxiphoid versus video-thoracoscopic pericardial "window".
abstract: BACKGROUND
  It remains undefined whether surgical subxiphoid drainage or thoracoscopic pericardial "window" is the optimal operative approach to pericardial effusion. We hypothesized that the true window into the pleural space created by the latter might improve the duration of freedom from recurrent effusion.
  
  
  METHODS
  We conducted a retrospective chart review of indications, preoperative and intraoperative variables, morbidity, recurrence, and survival.
  
  
  RESULTS
  Fifty-six patients underwent the subxiphoid procedure and 15 underwent the thoracoscopic procedure. Echocardiographic evidence of tamponade was present before 8 of 10 thoracoscopic procedures (80%) and 43 of 56 subxiphoid procedures (81%) for which descriptions of hemodynamics were available. In addition, non-pericardial procedures were performed in 10 (67%) and 18 (32%) patients, respectively (p = 0.020). Anesthesia time was longer at thoracoscopy (117.1 +/- 32.4 vs 81.1 +/- 25.5 minutes; p < 0.001). Procedural morbidity was higher after thoracoscopy (4 [27%] vs 1 [2%]; p = 0.006), but was generally minor. Hospital mortality tended to be higher after the subxiphoid procedure (7 [13%] vs 0 [0%]; p = 0.332), but none of the deaths was procedure-related. Follow-up was complete for 65 patients (92%). Recurrence occurred in 1 thoracoscopy patient (8%) and 5 subxiphoid patients (10%) (p = 1.000). Mean time to recurrence by Kaplan-Meier analysis trends were longer after thoracoscopy (36.1 vs 11.4 months; p = 0.16), and multivariate analysis identified the thoracoscopic approach as an independent predictor of freedom from recurrence (relative risk, 0.41; p = 0.014).
  
  
  CONCLUSIONS
  Operative time and minor procedural morbidity are higher with thoracoscopic pericardial window, but long-term control of effusion seemed to be better than after subxiphoid surgical drainage.
authors.affiliation: Section of General Thoracic Surgery, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania, USA.
authors.forename: Patrick K H
authors.initials: PK
authors.lastname: O'Brien
authors.forename: John C
authors.initials: JC
authors.lastname: Kucharczuk
authors.forename: M Blair
authors.initials: MB
authors.lastname: Marshall
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Friedberg
authors.forename: Zhen
authors.initials: Z
authors.lastname: Chen
authors.forename: Larry R
authors.initials: LR
authors.lastname: Kaiser
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Shrager
mesh_terms: D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010491:Pericardial Window Techniques / Q000009:adverse effects; D011183:Postoperative Complications / Q000453:epidemiology; D012189:Retrospective Studies; D020775:Thoracic Surgery, Video-Assisted / Q000009:adverse effects / Q000379:methods*