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Comparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial Window in Patients Requiring Drainage of Pericardial Effusions

https://doi.org/10.1016/j.amjcard.2017.06.003Get rights and content

Comparative outcomes of patients undergoing pericardiocentesis or pericardial window are limited. Development of pericardial effusion after cardiac surgery is common but no data exist to guide best management. Procedural billing codes and Cleveland Clinic surgical registries were used to identify 1,281 patients who underwent either pericardiocentesis or surgical pericardial window between January 2000 and December 2012. The 656 patients undergoing an intervention for a pericardial effusion secondary to cardiac surgery were also compared. Propensity scoring was used to identify well-matched patients in each group. In the overall cohort, in-hospital mortality was similar between the group undergoing pericardiocentesis and surgical drainage (5.3% vs 4.4%, p = 0.49). Similar outcomes were found in the propensity-matched group (4.9% vs 6.1%, p = 0.55). Re-accumulation was more common after pericardiocentesis (24% vs 10%, p <0.0001) and remained in the matched cohorts (23% vs 9%, p <0.0001). The secondary outcome of hemodynamic instability after the procedure was more common in the pericardial window group in both the unmatched (5.2% vs 2.9%, p = 0.036) and matched cohorts (6.1% vs 2.0%, p = 0.022). In the subgroup of patients with a pericardial effusion secondary to cardiac surgery, there was a lower mortality after pericardiocentesis in the unmatched group (1.5% vs 4.6%, p = 0.024); however, after adjustment, this difference in mortality was no longer present (2.6% vs 4.5%, p = 0.36). In conclusion, both pericardiocentesis and surgical pericardial window are safe and effective treatment strategies for the patient with a pericardial effusion. In our study there were no significant differences in mortality in patients undergoing either procedure. Observed differences in outcomes with regard to recurrence rates, hemodynamic instability, and in those with postcardiac surgery effusions may help to guide the clinician in management of the patient requiring therapeutic or diagnostic drainage of a pericardial effusion.

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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