MiscellaneousComparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial Window in Patients Requiring Drainage of Pericardial Effusions
Section snippets
Methods
The study population consists of patients who underwent either percutaneous pericardiocentesis or surgical pericardial window for treatment of a pericardial effusion at the Cleveland Clinic main campus between January 1, 2000 and December 31, 2012. Patients were identified through the use of International Classification of Diseases (ICD) procedural billing codes (ICD9 codes: 37.0 and 37.12), the Cardiovascular Information Registry, and the Thoracic Surgery Database, and confirmed through chart
Results
Characteristics of the study population and the 2 study groups are listed in Table 1. Etiologies of the overall cohort and each group are listed in Figure 2. Effusions owing to cardiac surgery were more common in the pericardial window group; however, effusions secondary to procedural trauma, such as coronary perforation, during cardiac ablation or during device implantation, were more likely to have pericardiocentesis. Patients who underwent pericardial windows were more likely to have a
Discussion
The pericardial cavity normally contains 10 to 50 ml of serous plasma ultrafiltrate. Accumulation of transudative or exudative fluid in excess of as little as >50 ml is considered abnormal and may lead to significant hemodynamic effects caused by cardiac compression and impairing cardiac filling.4 When this occurs and patients develop clinical signs and symptoms of cardiac tamponade, drainage is recommended. Drainage is also recommended in moderate or large effusions not responsive to medical
Disclosures
The authors have no conflicts of interest to disclose.
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Pericardial Involvement in Sarcoidosis
2022, American Journal of CardiologyCitation Excerpt :In patients who are critically unstable, pericardiocentesis is often preferred because of its rapid availability and shorter treatment time.28 However, localized effusions that are not easily accessed percutaneously often require surgical drainage.28 Ultimately, patients with refractory pericarditis may undergo radical pericardiectomy for definitive symptom resolution.
Pericardial Decompression Syndrome: A Case Series and Literature Review
2022, CJC OpenCitation Excerpt :We identified similar results, with a mean drainage volume of 1266 ± 887 mL, suggesting that higher volumes drained are more likely to result in PDS. Further reports have shown a significant difference in development of PDS in patients undergoing pericardiostomy vs pericardiocentesis, with higher rates for pericardiostomy (5% vs 3%, P = 0.036),7 and some reports of higher PDS mortality with pericardiostomy.7 Despite advances in research, few evidence-based guidelines exist advising on safe pericardial drainage techniques.
A contemporary look at pericardiocentesis
2019, Trends in Cardiovascular MedicineCitation Excerpt :Recurrences after a pericardiocentesis are rather frequent, certainly when no pericardial drain is left in place for at least 24–48 h after the pericardiocentesis [49]. Registries suggest that recurrences affect 1 out of every 4 patient after a pericardiocentesis [29,50]. Often, a new pericardiocentesis is then unavoidable.
Clinical Update in Pericardial Diseases
2019, Journal of Cardiothoracic and Vascular AnesthesiaCitation Excerpt :A recent retrospective study of 1,281 patients of which 760 underwent pericardiocentesis and 521 had surgical drainage showed no difference for in-hospital mortality between the groups. The pericardiocentesis group had higher rates of reaccumulation (24% v 10%, p < 0.0001), but postprocedural hemodynamic instability was more common in the surgical drainage group (5.2% v 2.9%, p = 0.036).37 Percutaneous balloon pericardiotomy is an interventional technique that combines traditional subxiphoid pericardiocentesis and the inflation of a balloon at the level of the parietal pericardium to allow for improved drainage of an effusion.
A fluid relationship: Calcineurin inhibitors and pericardial effusions
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