Cor Vasa 2002, 43(9):375-379
Video-assisted thoracoscopic drainage of pericardial effusion
- II. chirurgická klinika kardiovaskulární chirurgie, Všeobecná fakultní nemocnice a 1. lékařská fakulta Univerzity Karlovy, Praha, Česká republika
Objective:
The aim of this study is to assess the validity of video-assisted thoracoscopy (VATS), which enabled visual control and targeted pericardial biopsy in the treatment of chronic pericardial effusions, and to compare this approach with subxiphoid pericardiotomy.
Methods:
From September 1995 through January 2002, two types of surgical evacuation of pericardial fluid under pressure were studied in our institution. Subxiphoid pericardiotomy was performed in 23 patients (group A) and 11 patients (group B) underwent VATS under echocardiographic guidance. In the latter case, the thoracic cavity was inspected, the pericardial effusion was drained, and a pleuropericardial window was performed. There were more patients with the postpericardiotomy syndrome following cardiac surgery and located effusions, or an effusion with dense echoes suggesting the presence of both thrombus and free fluid in group B (54% vs. 17%, p = 0.041). The primary malignant disease as a cause of pericardial effusion occurred with the same frequency in both groups (52% vs. 48%, NS).
Results:
There was no difference in early postoperative outcomes between the two groups. At 84 months of follow-up in group A, six patients (26 per cent) had recurrent effusions, and two patients (8.5 per cent) required reoperation. There was no recurrence of pericardial effusions or need of reintervention in group B with a shorter mean follow-up (8 months). There were seven late deaths in group A (30%) and 2 in group B (17%), predominantly in patients with malignant effusions. None of the patients with the postpericardiotomy syndrome has died.
Conclusions:
The less invasive subxiphoid pericardiotomy should be chosen as a palliative procedure in patients who are critically ill, hemodynamically unstable or with limited expected survival and, in contrast to initial palliative pericardiocentesis, offers only the advantage of rapid pericardial sac decompression. The long-term effect of this procedure depends on the etiology of effusion and on potential for recurrence. In a stable patient, when a pleuropericardial window is indicated for prevention of recurrent pericardial effusions and balloon pericardiotomy is not available, video-assisted pericardiotomy is a safe technique that should be considered in the management of chronic pericardial effusions. When treatment of a located effusion or an effusion with both a thrombus and free fluid is needed, VATS appears to be more favorable compared with sternotomy or thoracotomy.
Keywords: Pericardial effusion; Video-assisted thoracoscopy
Published: September 1, 2002 Show citation