SUBXIPHOID PERICARDIAL WINDOW FOR PERICARDIAL-EFFUSION IN END-STAGE RENAL-DISEASE

Fifty-seven patients with end-stage renal disease who were on maintena nce dialysis underwent pericardial fluid drainage surgically between J anuary 1980 and December 1991. All patients had echocardiographically proven pericardial effusion of more than 300 to 500 mL. Seven patients had pericardiectomy by left thoracotomy under general anesthesia in t he first 2 years. Subsequently, 50 patients underwent a subxiphoid per icardial window by a left subcostal incision, A pericardial drainage t ube was inserted at surgery and removed after 4 to 5 days, All but fiv e patients undergoing subxiphoid pericardial window surgery received l ocal anesthesia, The xiphoid process was not resected during surgery a nd steroids were not instilled in the pericardial cavity, There were m inimal complications, no surgery-related deaths, and no recurrence of fluid in patients after pericardial window surgery, With our present e xperience, we advise a subxiphoid pericardial window with pericardial drainage under local anesthesia for all end-stage renal disease patien ts on dialysis who have a symptomatic or large pericardial effusion of more than 300 to 500 mt. Steroid instillation is not necessary for th e prevention of recurrence of effusion. (C) 1996 by the National Kidne y Foundation, Inc.