Endoscopic treatment for delayed cardiac tamponade

Cardiac tamponade occurring during the late postoperative period after open-heart surgery is an extremely serious complication. One surgical therapy is a finger dissection through subxiphoid incision. The main limitation is an incomplete view into the pericardial sac. To make subxiphoid exploration more effective, we developed a novel technique of endoscope-assisted removal of delayed cardiac tamponade through subxiphoid pericardiotomy. Surgery was performed under optical guidance of an endoscopic retractor routinely used for harvesting saphenous veins for bypass grafting. After the subxiphoid pericardiotomy, we introduced the endoscopic retractor into the pericardial space, and the haematoma was completely evacuated using a suction apparatus and endoscopic forceps. Between January 2008 and March 2009, three patients underwent endoscope-assisted removal of late cardiac tamponade. The haematoma was completely removed without re-sternotomy. No bleeding or tamponade occurred following the procedure. An endoscopic approach for treating late cardiac tamponade provides the advantages of minimally invasive surgery through subxiphoid pericardiotomy combined with an optimal surgical perspective. This novel technique permits exploration of the pericardium and helps prevent new wounds.