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Pericardial drainage: subxiphoid vs. transthoracic approach
K S Naunheim1, K A Kesler, A C Fiore
1Department of Cardiothoracic Surgery, St. Louis University Medical Center, MO.
Summary
Subxiphoid and transthoracic drainage for effusive pericardial disease show similar recurrence and survival rates. Transthoracic procedures had higher respiratory complications and longer hospital stays.
Area of Science:
- Cardiology
- Thoracic Surgery
- Pericardial Diseases
Background:
- Optimal management of effusive pericardial disease is debated.
- Subxiphoid drainage has high recurrence rates; transthoracic procedures carry greater morbidity risks.
Purpose of the Study:
- Compare subxiphoid (SX) and transthoracic (TT) drainage for effusive pericardial disease.
- Evaluate operative mortality, complications, recurrence, and survival rates.
Main Methods:
- Retrospective comparison of 131 patients undergoing SX or TT drainage.
- Analysis of patient demographics, effusion etiology, fluid volume, operative mortality, complications, hospital stay, recurrence, and survival.
Main Results:
- No significant difference in operative mortality (SX 15%, TT 13%) or 5-year survival (SX 54%, TT 49%).
- Transthoracic group had significantly higher respiratory complications (35% vs. 11%) and longer hospital stays (14.4 vs. 11.4 days).
- Recurrence rates were similar (SX 89%, TT 93% freedom from recurrence), with successful non-reoperative management.
Conclusions:
- Both subxiphoid and transthoracic drainage offer comparable long-term outcomes for effusive pericardial disease.
- Transthoracic procedures are associated with increased respiratory complications and prolonged hospitalization.