LONG-TERM RESULTS OF SURGICAL SUBXIPHOID PERICARDIAL DRAINAGE

A series of 64 consecutive patients who underwent surgical subxiphoid drainage of pericardial effusion over an 11-year period, was analysed both for recurrence of pericardial pathology and survival. The mean fo llow-up time was 4 years (6 months to 10 years). Twelve patients had r ecurrent effusion (18%), all except one within 6 months: six patients (9%) had another drainage procedure which was the definitive treatment except in one terminal cancer patient with intractable malignant effu sion who died of cardiac tamponade. The remaining six recurrent effusi ons could be treated conservatively. One patient with idiopathic effus ion developed late constrictive pericarditis. Patients with underlying malignancy (n=26) had significantly worse actuarial survival than the others (actuarial survival at 1 and 5 years of 51% and 0% vs 87% and 76%, respectively). However, their probability of remaining free of re currence did not differ significantly (actuarial freedom at 1 year of 89% vs 76%). In conclusion, subxiphoid drainage provides a simple, saf e and expeditious treatment of most symptomatic pericardial effusions with one in ten patients requiring a repeat drainage for recurrence. I n particular, it offers a good palliation in most patients with underl ying neoplastic disease. Routine echocardiography is recommended at on e and six months to catch most of the recurrent effusions.