title: Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention.
abstract: OBJECTIVE
  The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions.
  
  
  METHODS
  From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized.
  
  
  RESULTS
  There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1-85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362-6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009-50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100-3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048-2.90 P = 0.032) were the three independent predictors of postoperative death.
  
  
  CONCLUSIONS
  In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients.
authors.affiliation: Chronic Respiratory Disease Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran.
authors.forename: Seyed Mohsen
authors.initials: SM
authors.lastname: Mirhosseini
authors.forename: Mohammad
authors.initials: M
authors.lastname: Fakhri
authors.forename: Amirhossein
authors.initials: A
authors.lastname: Mozaffary
authors.forename: Mojtaba
authors.initials: M
authors.lastname: Lotfaliany
authors.forename: Neda
authors.initials: N
authors.lastname: Behzadnia
authors.forename: Zahra
authors.initials: Z
authors.lastname: Ansari Aval
authors.forename: Seyed Mohammad Saeed
authors.initials: SM
authors.lastname: Ghiasi
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Boloursaz
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Masjedi
mesh_terms: D000328:Adult; D000368:Aged; D002305:Cardiac Tamponade / Q000209:etiology; D016009:Chi-Square Distribution; D004417:Dyspnea / Q000209:etiology; D004452:Echocardiography; D005260:Female; D006801:Humans; D007492:Iran; D053208:Kaplan-Meier Estimate; D008175:Lung Neoplasms / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009361:Neoplasm Invasiveness; D009369:Neoplasms / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D010491:Pericardial Window Techniques / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome