Pericardial effusion: Subxiphoid pericardiostomy versus percutaneous catheter drainage

Background. Optimal management of cardiac tamponade resulting from pericard ial effusion remains controversial. Methods. Cardiac tamponade in 117 patients was treated with either subxipho id pericardiostomy (n = 94) or percutaneous catheter drainage (n = 23). Per cutaneous catheter drainage was used for patients with hemodynamic instabil ity that precluded subxiphoid pericardiostomy. Effusions were malignant in 75 (64%) of 117 patients and benign in 42 (36%) of 117. Results. Subxiphoid pericardiostomy had no operative deaths and a complicat ion rate of 1.1% (1 of 94). In contrast, percutaneous drainage had signific antly (p < 0.05) higher mortality and complication rates of 4% (1 of 23) an d 17% (4 of 23), respectively. Patients with an underlying malignancy had a median survival of 2.2 months, with a 1-year actuarial survival rate of 13 .8%. In comparison, patients with benign disease had a median survival of 4 2.8 months and a 1-, 2-, and 4-year actuarial survival rate of 79%, 73%, an d 49%, respectively (p < 0.05). Effusions recurred in 1 (1.1%) of 94 patien ts after subxiphoid pericardiostomy compared with 7 (30.4%) of 23 patients with percutaneous drainage (p < 0.0001). Conclusions. Benign and malignant pericardial tamponade can be safely and e ffectively managed with subxiphoid pericardiostomy. Percutaneous catheter d rainage should be reserved for patients with hemodynamic instability. (C) 1 999 by The Society of Thoracic Surgeons.