PURPOSE: Pericardial effusion complicates many disease processes, both benign and malignant. A variety of treatments are available, including observation, anti-inflammatory or anti-neoplastic therapy, pericardiocentesis, percutaneous catheter drainage, and surgical procedures, including open subxiphoid window and thoracoscopic drainage. We report our experience with minimally invasive thoracoscopic pericardial window for treatment of pericardial effusion secondary to a variety of etiologies.
METHODS: Retrospective review of 21 patients treated for pericardial effusion between 2004 and 2006 at a tertiary care center. There where 11 female and 10 male patients. The diagnosis of pericardial effusion was established by echocardiography and quantified into small, medium and large. Medium and large size effusions were selected for thoracoscopic drainage through a standard three port technique that included creation of a large pericardial window over the right atrium.
RESULTS: The etiology of pericardial effusion included idiopathic (5), acute or chronic inflammatory (5), metastatic (3), post-coronary revascularization (3), constrictive pericarditis (2), systemic lupus erythematosus (1), purulent pericarditis (1) and multisystem organ failure (1). . Fifteen patients where previously treated with other modalities including previous pericardiocentesis and catheter placement. Mean effusion size was 340+170 ml. None of the cases required conversion to open drainage. Mean length of hospital stay was 5 days (range 3 to 16). One case required reoperation (4.5%) and pericardiectomy for constrictive pericarditis. Mean follow-up was 8 months (range 3 to 24 months). No reoperations were performed for recurrent pericardial effusion. There was no mortality.
CONCLUSION: Thoracoscopic pericardial window and drainage of effusion is an effective treatment for pericardial effusion secondary to a variety of etiologies and results in low rates of reoperation or recurrent effusion. It can be performed with low morbidity and mortality.
CLINICAL IMPLICATIONS: Thoracoscopic pericardial window and drainage of effusion should be considered as the treatment of choice for patients requiring surgical intervention. Comparative studies with subxiphoid approach are encouraged.
DISCLOSURE: Bill Chiu, No Financial Disclosure Information; No Product/Research Disclosure Information