Comparative study of subxiphoid versus video-thoracoscopic pericardial "window"

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Pericardial Diseases

Background:

• Optimal surgical approach for pericardial effusion remains undefined.
• Comparing subxiphoid drainage and thoracoscopic pericardial window.
• Hypothesis: Thoracoscopic window improves freedom from recurrent effusion.

Purpose of the Study:

• Evaluate operative approaches for pericardial effusion.
• Compare subxiphoid drainage versus thoracoscopic pericardial window.
• Assess recurrence rates and long-term outcomes.

Main Methods:

• Retrospective chart review of 71 patients.
• Analysis of indications, operative variables, morbidity, recurrence, and survival.
• Kaplan-Meier and multivariate analyses for recurrence-free survival.

Main Results:

• Thoracoscopic procedures had longer anesthesia times and higher minor procedural morbidity.
• Recurrence rates were similar (8% thoracoscopy vs. 10% subxiphoid).
• Thoracoscopic approach was an independent predictor of freedom from recurrence (RR 0.41, p=0.014).

Conclusions:

• Thoracoscopic pericardial window has increased operative time and minor morbidity.
• Long-term effusion control appears superior with thoracoscopic pericardial window.
• Thoracoscopic approach is associated with reduced recurrence risk.