Pericardiocentesis versus pericardial window surgery in malignant pericardial effusion: trends and clinical outcomes
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Abstract Backgrounds Pericardial effusion (PE) is often an obstacle to cancer treatment and a life-threatening factor. Although cancer survival has improved over the past two decades, an appropriate treatment method for PE in cancer patients has not yet been established. The purpose of this study was to investigate the temporal trends and clinical results in the method of drainage of PE. Methods Between 2003 and 2022, 744 consecutive patients with malignant PE who underwent pericardial drainage were retrospectively analyzed. The patients were divided according to the time of pericardial drainage (Period 1: 2003-2012, Period 2: 2013-2022) and initial drainage method (pericardiocentesis vs. window surgery). The rates of all-cause death and redo pericardial drainage for recurrent PE were compared according to the drainage methods. Results In comparison with Period 1, there was an increasing number of patients who underwent pericardial drainage in Period 2 (235 vs. 509). However, the proportion of window surgery decreased (21.7 vs. 14.9%, P=0.029). The median survival time of patients was improved (4.4 vs. 6.3 months, log-rank P<0.001). There was no significant difference in all-cause death and 30-day mortality (24.4 vs. 18.6%, P=0.171) after drainage between surgery and pericardiocentesis groups. The window surgery group had a significantly lower incidence of redo pericardial drainage than the pericardiocentesis group (hazard ratio [HR]: 0.49, 95% confidence interval [CI]: 0.26–0.91, P=0.022). In Period 1, there was no significant difference in redo pericardial drainage between window surgery and pericardiocentesis (HR: 0.78, 95% CI: 0.35–1.74, P=0.540). However, the window surgery group had significantly lower redo pericardial drainage than the pericardiocentesis group in Period 2(HR: 0.33, 95% CI: 0.12–0.91, P=0.024). Conclusions The window surgery was safe in cancer patients. As cancer survival rates improve, surgery showed benefits in reducing redo pericardial drainage. Pericardial window surgery could be preferred over pericardiocentesis in patients who expected longer life expectancy.Keywords:
Pericardiocentesis
Pericardial window
Background: Existing data, which compare the outcomes of surgical pericardial window operation versus pericardiocentesis in patients with significant pericardial effusion indicated for drainage, are limited and not enough to guide the best management option for these patients.Here, we examined the results for individuals who were treated for pericardial effusion with either pericardiocentesis or a surgical pericardial window.Patients and methods: A retrospective, single-center, observational, comparative study of patients who were admitted to the Cardiothoracic Surgery Department, Tanta University.Between January 2018 and December 2022.200 individuals with pericardial window surgery or pericardiocentesis were identified using hospital registries.Results: Both surgical pericardial window and pericardiocentesis were beneficial in this research for treating patients with substantial pericardial effusion, and there was an insignificant difference in overall mortality between the two procedures.Nevertheless, there were disparities between the two approaches, with more patients requiring further treatments if the fluid was drained with pericardiocentesis, as well as a higher rate of residual pericardial effusion and re-accumulation of pericardial effusion in the pericardiocentesis group. Conclusion :The surgical pericardial window operation is superior to pericardiocentesis in the management of patients with significant pericardial effusion indicated for drainage with regard to the incidence and amount of residual effusion and as regards to the occurrence of pericardial effusion re-accumulation; however, both techniques are safe, life-saving and effective approaches for the management of patients with instances of cardiac tamponade and severe pericardial effusion.
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Background: Pericardial effusion is a common entity in cardiology practice, often an incidental finding on echocardiographic or computed tomographic imaging. Pericardiocentesis can be performed for...
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Pericardiocentesis
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We retrospectively reviewed the records of 100 patients with malignant disease and symptomatic pericardial effusion initially treated with pericardiocentesis at the National Cancer Institute of Mexico between 1985 and 2009. We analyzed predictive factors for recurrence of pericardial effusion by bi- and multivariate analyses. The group comprised 74 women and 26 men. Twenty patients had developed malignant pericardial effusion at the time of primary cancer diagnosis. Recurrence rate after pericardiocentesis was 33%. Progression-free survival for pericardial effusion at one year was 59% (range, 47-71%). Median overall survival (OS) after pericardiocentesis was 40.3+/-7.9 weeks (95% Confidence interval, 24.9-55.7). The sole factor that correlated with increased progression-free survival for pericardial effusion was the presence of bloody pericardial effusion. For OS, multivariate analysis yielded that female gender and presence of pericardial effusion at time of primary malignancy diagnosis were associated with higher life expectancy. Initial pericardiocentesis can provide successful management of patients with a control rate of 67%. In spite of the high effectiveness of the primary management of pericardial effusion with pericardiocentesis in oncologic patients, it might be considered for initial treatment, especially those with poor prognosis, leaving pericardial window as a secondary strategy for recurrence.
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Background:The clinical course of malignancies is frequently complicated by third spacing in body cavities, including pericardial effusion.What remains the optimal management for malignant pericardial effusion is a dilemma.Aim: We aimed to compare 30-day outcomes of imaging-guided pericardiocentesis and surgical pericardial window in patients with malignant pericardial effusion.Methods: A retrospective observational study was done at a tertiary care hospital.We reviewed hospital record files of 91 consecutive patients admitted with malignant pericardial effusion from January 2010 to December 2019 and requiring imaging-guided pericardiocentesis or pericardial window.Results: A total of 71 patients were included in the final analysis.Most patients were male (68%).The mean age was 45 years.Hypertension was the most common comorbid condition.Lymphoma or leukemia (39%) was the most common cause of malignant pericardial effusion followed by lung cancer (28%).About 57.7% of patients underwent pericardiocentesis, and the remainder underwent surgical pericardial window (42.3%).The overall procedural success was 97.2%, and the overall mortality was 5.6%.The success rate was similar when pericardiocentesis was compared with the surgical pericardial window (p = 0.22).The length of hospital stay was higher in patients undergoing pericardial window (p = 0.007), whereas the re-accumulation rate was higher in the pericardiocentesis group (0% versus 34%, p < 0.001).Patients undergoing pericardial window had higher odds of major bleeding requiring transfusions.Conclusion: There is a higher rate of recurrence following isolated pericardiocentesis but a comparable mortality difference between the two procedures.Complication rates can be reduced by improving surgical technique and peri-operative management.Meticulous surgical care, infection precautions, and good glycemic control in this immunocompromised subset can preserve the pericardial window as a better management option.Relevance to Patients: Pericardial window is a promising and effective management option for patients with recurrent malignant pericardial effusion, but it comes at the cost of bleeding and infection.More extensive trials are needed to understand better the long-term outcomes of pericardial window or pericardiocentesis in patients with malignant effusion.
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The hemodynamic stability of the heart and pericardium are maintained by the pericardial fluid of volume ∼10-50 ml. Pericardial effusion is associated with the abnormal accumulation of pericardial fluid in the pericardial cavity. Numerous imaging techniques are utilized to evaluate pericardial effusion including chest X-ray, electrocardiogram, transthoracic echocardiography, computed tomography scan, cardiac magnetic resonance imaging, and pericardiocentesis. Once diagnosed, there are numerous treatment options available for the management of patients with pericardial effusion. These include various invasive and non-invasive strategies such as pericardiocentesis, pericardial window, and sclerosing therapies. In recent times, few studies have been conducted to evaluate the safety and efficacy of each approach in routine clinical practice. In this review, we review the role of different modalities in the diagnosis of pericardial effusion while highlighting existing therapies aimed at the management and treatment of pericardial effusion.
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