title: Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: experience of a centre without cardiothoracic surgery.
abstract: BACKGROUND
  Cardiac tamponade has been reported in 18.7% of patients with acute type A aortic dissection and its presence is associated with worse outcomes. Emergency aortic repair together with intra-operative pericardial drainage is the recommended treatment approach. However, controversy surrounds how to manage patients with haemopericardium and cardiac tamponade who cannot survive until surgery.
  
  
  OBJECTIVE
  To describe a case series of patients with critical cardiac tamponade complicating aortic dissection admitted to a hospital without cardiothoracic surgery, and in whom preoperative controlled pericardial drainage was performed.
  
  
  RESULTS
  Single centre retrospective study: during a nine-year period, 21 patients with Stanford type A aortic dissection were admitted at our centre; six of them (28.6%) presented clinical and echocardiographic signs of cardiac tamponade (four males; mean age 58±17 years). In this subgroup, controlled pericardiocentesis was safely performed with no major immediate complications and it was effective in five patients, improving haemodynamic instability and allowing transfer to the operating room.
  
  
  CONCLUSIONS
  Preoperative controlled pericardiocentesis can be lifesaving when managing patients with critical cardiac tamponade (pulseless electrical activity or refractory hypotension) complicating acute type A aortic dissection, namely when cardiac surgery is not immediately available.
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal inesmariarosariocruz@gmail.com.
authors.forename: Inês
authors.initials: I
authors.lastname: Cruz
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Bruno
authors.initials: B
authors.lastname: Stuart
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Daniel
authors.initials: D
authors.lastname: Caldeira
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Gonçalo
authors.initials: G
authors.lastname: Morgado
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Ana C
authors.initials: AC
authors.lastname: Gomes
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Ana R
authors.initials: AR
authors.lastname: Almeida
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Maria J
authors.initials: MJ
authors.lastname: Loureiro
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Isabel
authors.initials: I
authors.lastname: João
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Carlos
authors.initials: C
authors.lastname: Cotrim
authors.affiliation: Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal.
authors.forename: Hélder
authors.initials: H
authors.lastname: Pereira
mesh_terms: D000328:Adult; D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000209:etiology; D017545:Aortic Aneurysm, Thoracic / Q000150:complications*; D006348:Cardiac Surgical Procedures; D002305:Cardiac Tamponade / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D017548:Echocardiography, Transesophageal / Q000379:methods; D004562:Electrocardiography; D005260:Female; D006757:Hospital Units; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D010490:Pericardial Effusion / Q000000981:diagnostic imaging* / Q000209:etiology / Q000601:surgery*; D020519:Pericardiocentesis / Q000295:instrumentation / Q000379:methods*; D012189:Retrospective Studies; D012307:Risk Factors; D016896:Treatment Outcome
keywords: Aortic dissection; cardiac tamponade; pericardiocentesis