ISSN 2564-7784 | E-ISSN 2564-7040
Original Article
Comparative Evaluation of Thoracoscopic Pericardial Drainage and Subxiphoid Tube Insertion in Patients with Prior Cardiac Surgery
1 Gaziantep University Faculty of Medicine, Cardiovascular Surgery Department, Gaziantep, Turkey  
2 Burhan Nalbantoğlu City Hospital, Cardiovascular Surgery Department, Nichosia, Cyprus  
Eur J Ther ; : -
DOI: 10.5152/EurJTher.2019.19067
Key Words: Pericardial effusion, cardiac surgery, thoracoscopy.
Abstract

Objectives: Clinically symptomatic pericardial effusion (PE) develops in 0.8-6% of patients after the open heart surgery and delayed effusion is related to morbidity. Comparative results of thoracoscopic pericardial drainage and subxiphoid tube pericardiostomy, which is the standard surgical procedure, had been scantily reported.

 

Methods: We conducted a longitudinal observation of late-presenting PEs treated with the thoracoscopic pericardial drainage (TPD group; 48 patients) and subxiphoid pericardiostomy (SX group; 91 patients) between May 2012 and June 2017. Changes in hemodynamic parameters, functional status of the patients and results of the procedures were compared between both procedures.

 

Results: The TPD group have a significantly greater size of effusion (3.9±0.6 cm vs. 3.1±0.5 cm; p<0.01), higher pulmonary artery pressure (41.2±9.8 mmHg vs. 36.4±5.6 mmHg; p<0.01) and less time interval to emerge the symptoms (6[3-15] weeks vs. 8[3-21] weeks; p<0.01). Though the mean operation time was shorter in the subxiphoid group (44.6±12.2 min vs 69.2±22.3 min, p<0.01), the same amount of fluid was drained (637.9±182.9 mL vs. 661.3±168.4 mL, p=0.45). Improvements in postoperative hemodynamic variables and functional status following both procedures were similar, but symptomatic and echocardiographic recurrence of effusion was significantly more in the subxiphoid group (19 patients; 20.9% vs. 2 patients; 4.2%, p<0.01) within about 2 years of follow-up.

 

Conclusion: The post-pericardiotomy effusion is a chronic inflammatory process and the subxiphoid drainage serves a temporary solution. TPD may serve equally favorable surgical outcomes, though they were performed for the treatment of more complicated PEs.

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