Subxiphoid Approach for Treatment of Pericardial Effusion

Abstract

Subxiphoid pericardiotomy was the primary treatment in 305 patients with pericardial effusion from January 1984 to June 1996. There were 198 males and 107 females, ages ranged from 15 days to 75 years. The procedure was carried out with local anesthesia and sedation in 263 (86.2%) patients and under general anesthesia in 42 (13.8%). Median drainage was 975.25 ± 48.46 mL in 264 patients with benign effusion and 1131.25 ± 97.48 mL in 41 (13.4%) with malignant disease; cytology was positive in 14 of 38 (36.8%) and pericardial biopsy showed cancer in 12 of 36 (33.3%). Intraoperative complications in 22 patients (7.2%) included cardiac arrest in 12 (3.9%) of whom, 7 (2.3%) died. Overall 30-day mortality was 16.3%; it was 46.3% (19/41) in malignant cases versus 11.7% (31/264) in cases of benign effusion. Follow-up of 234 (91.8%) hospital survivors for 18 ± 3.62 months (range, 2 to 54 months) showed recurrent pericardial effusion needing further intervention in 31 (13.2%) of whom, 8 had cancer and 23 had benign disease. Median survival in benign cases was more than 107 days versus 56 days in malignant cases. Because of its acceptable mortality and morbidity, subxiphoid pericardiotomy is recommend as an initial procedure.