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Retrospective Comparison of Outcomes, Diagnostic Value, and Complications of Percutaneous Prolonged Drainage Versus Surgical Pericardiotomy of Pericardial Effusion Associated With Malignancy

      Surgical pericardiotomy is often preferred as a primary option in patients with malignant pericardial effusions. Recent series have revealed that prolonged drainage substantially reduces pericardial effusion recurrence rates, even in the setting of malignancy. The aim of the study was to directly compare the efficacy of pericardiocentesis with prolonged drainage with the primary surgical pericardiotomy in patients with symptomatic pericardial effusion associated with a malignancy. We retrospectively evaluated 88 patients who presented with pericardial tamponade associated with a malignancy. Pericardiocentesis with extended drainage was performed in 43 patients and surgical pericardiotomy in 45 patients. The recurrence rate was not significantly different in patients with prolonged catheter drainage versus surgical pericardiotomy (12% vs 13%, respectively, p = 0.78). In addition, there was no significant difference in diagnostic yield between percutaneous drainage and surgical window (44% vs 53%, respectively, p = 0.39). The overall rate of complications was significantly lower in the prolonged drainage group (2% vs 20%, p = 0.007). Moreover, there were no serious complications in the prolonged drainage group versus 9% in the surgical pericardiotomy group. In conclusion, (1) surgical pericardiotomy with pericardial biopsy does not add significant diagnostic value beyond the cytologic assessment available with pericardiocentesis, (2) surgical pericardiotomy does not improve clinical outcomes over pericardiocentesis, and (3) surgical pericardiotomy is associated with a higher rate of complications.
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      References

        • Ben-Horin S.
        • Bank I.
        • Guetta V.
        • Livneh A.
        Large symptomatic pericardial effusion as the presentation of unrecognized cancer: a study in 173 consecutive patients undergoing pericardiocentesis.
        Medicine. 2006; 85: 49-53
        • Celermajer D.S.
        • Boyer M.J.
        • Bailey B.P.
        • Tattersall M.H.
        Pericardiocentesis for symptomatic malignant pericardial effusion: a study of 36 patients.
        Med J Aust. 1991; 154: 19-22
        • Rafique A.M.
        • Patel N.
        • Biner S.
        • Eshaghian S.
        • Mendoza F.
        • Cercek B.
        • Siegel R.J.
        Frequency of recurrence of pericardial tamponade in patients with extended versus nonextended pericardial catheter drainage.
        Am J Cardiol. 2011; 108: 1820-1825
        • Tsang T.S.
        • Seward J.B.
        • Barnes M.E.
        • Bailey K.R.
        • Sinak L.J.
        • Urban L.H.
        • Hayes S.N.
        Outcomes of primary and secondary treatment of pericardial effusion in patients with malignancy.
        Mayo Clin Proc. 2000; 75: 248-253
        • Laham R.J.
        • Cohen D.J.
        • Kuntz R.E.
        • Baim D.S.
        • Lorell B.H.
        • Simons M.
        Pericardial effusion in patients with cancer: outcome with contemporary management strategies.
        Heart. 1996; 75: 67-71
        • Vaitkus P.T.
        • Herrmann H.C.
        • LeWinter M.M.
        Treatment of malignant pericardial effusion.
        JAMA. 1994; 272: 59-64
        • Tsang T.S.
        • Enriquez-Sarano M.
        • Freeman W.K.
        • Barnes M.E.
        • Sinak L.J.
        • Gersh B.J.
        • Bailey K.R.
        • Seward J.R.
        Consecutive 1127 therapeutic echocardiographically guided pericardiocenteses: clinical profile, practice patterns, and outcomes spanning 21 years.
        Mayo Clin Proc. 2002; 77: 429-436
        • Light R.W.
        • Macgregor M.I.
        • Luchsinger P.C.
        • Ball Jr., W.C.
        Pleural effusions: the diagnostic separation of transudates and exudates.
        Ann Intern Med. 1972; 77: 507-513
        • Horowitz M.S.
        • Schultz C.S.
        • Stinson E.B.
        • Harrison D.C.
        • Popp R.L.
        Sensitivity and specificity of echocardiographic diagnosis of pericardial effusion.
        Circulation. 1974; 50: 239-247
        • Callahan J.A.
        • Seward J.B.
        • Tajik A.J.
        Cardiac tamponade: pericardiocentesis directed by two-dimensional echocardiography.
        Mayo Clin Proc. 1985; 60: 344-347
        • Tsang T.S.
        • Freeman W.K.
        • Sinak L.J.
        • Seward J.B.
        Echocardiographically guided pericardiocentesis: evolution and state-of-the-art technique.
        Mayo Clin Proc. 1998; 73: 647-652
        • Cheitlin M.D.
        • Armstrong W.F.
        • Aurigemma G.P.
        • Beller G.A.
        • Bierman F.Z.
        • Davis J.L.
        • Douglas P.S.
        • Faxon D.P.
        • Gillam L.D.
        • Kimball T.R.
        • Kussmaul W.G.
        • Pearlman A.S.
        • Philbrick J.T.
        • Rakowski H.
        • Thys D.M.
        • Antman E.M.
        • Smith Jr., S.C.
        • Alpert J.S.
        • Gregoratos G.
        • Anderson J.L.
        • Hiratzka L.F.
        • Hunt S.A.
        • Fuster V.
        • Jacobs A.K.
        • Gibbons R.J.
        • Russell R.O.
        • American College of Cardiology
        • American Heart Association
        • American Society of Echocardiography
        ACC/AHA/ASE 2003 guideline update for the clinical application of echocardiography: summary article: a report of the American College of Cardiology/American Heart Association Task Force on Practice Guidelines.
        Circulation. 2003; 108: 1146-1162
        • Cullinane C.A.
        • Paz I.B.
        • Smith D.
        • Carter N.
        • Grannis Jr., F.W.
        Prognostic factors in the surgical management of pericardial effusion in the patient with concurrent malignancy.
        Chest. 2004; 125: 1328-1334
        • Van Trigt P.
        • Douglas J.
        • Smith P.K.
        • Campbell P.T.
        • Wall T.C.
        • Kenney R.T.
        • O'Connor C.M.
        • Sheikh K.H.
        • Corey G.R.
        A prospective trial of subxiphoid pericardiotomy in the diagnosis and treatment of large pericardial effusion.
        Ann Surg. 1993; 218: 777-782
        • Levin B.H.
        • Aaron B.L.
        The subxiphoid pericardial window.
        Surg Gynecol Obstet. 1982; 155: 804-806
        • Alcan K.E.
        • Zabetakis P.M.
        • Marino N.D.
        • Franzone A.J.
        • Michelis M.F.
        • Bruno M.S.
        Management of acute cardiac tamponade by subxiphoid pericardiotomy.
        JAMA. 1982; 247: 1143-1148
        • McDonald J.M.
        • Meyers B.F.
        • Guthrie T.J.
        • Battafarano R.J.
        • Cooper J.D.
        • Patterson G.A.
        Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion.
        Ann Thorac Surg. 2003; 76: 811-816
        • Palatino's G.M.
        • Thurber R.J.
        • Pompano M.Q.
        • Kaiser G.A.
        Clinical experience with subxiphoid drainage of pericardial effusions.
        Ann Thorac Surg. 1989; 48: 381-385
        • Allen K.B.
        • Faber L.P.
        • Warren W.H.
        • Shaar C.J.
        Pericardial effusion: subxiphoid pericardiotomy versus percutaneous drainage.
        Ann Thorac Surg. 1999; 67: 437-440
        • Geissbühler K.
        • Leiser A.
        • Fuhrer J.
        • Ris H.B.
        Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions.
        Eur J Cardiothorac Surg. 1998; 14: 403-408
        • Campbell P.T.
        • Van Trigt P.
        • Wall T.C.
        • Kenney R.T.
        • O'Connor C.M.
        • Sheikh K.M.
        • Baker M.E.
        • Corey G.R.
        Subxiphoid pericardiotomy in the diagnosis and management of large pericardial effusions associated with malignancy.
        Chest. 1992; 101: 938-943