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Pericardiocentesis in contemporary practice
Rebecca Inglis1, Andrew John King, Marcus Gleave
1Cardiology Department, Royal Berkshire Hospital, Reading, United Kingdom.
Insights
Pericardiocentesis, a life-saving procedure, has low complication rates. However, the subcostal approach was linked to all major complications requiring surgery, suggesting an apical approach may be preferable.
Area of Science:
- Cardiology
- Interventional Cardiology
- Medical Procedures
Background:
- Pericardiocentesis is a critical procedure for managing pericardial effusions.
- The choice between apical and subcostal approaches for pericardiocentesis has not been well-defined regarding complication rates.
- An increasing number of pericardial effusions are iatrogenic, often resulting from cardiac catheterization procedures.
Purpose of the Study:
- To examine current practices in pericardiocentesis.
- To analyze the complication rates associated with different pericardiocentesis approaches (apical vs. subcostal).
- To evaluate the impact of patient anticoagulation status on complication rates.
Main Methods:
- A historical cohort study was conducted.
- Data were collected from four hospitals in Oxfordshire between November 2002 and October 2009.
- Percutaneous pericardiocenteses were identified through local databases.
Main Results:
- A total of 188 pericardiocenteses were performed in 163 patients.
- Malignancy and catheter-based procedures were the most common indications for drainage.
- The overall complication rate was 4.8% (9/188), with all 4 major surgical complications occurring via the subcostal route.
Conclusions:
- A significant proportion of pericardiocenteses are performed in anticoagulated patients, particularly those with iatrogenic effusions.
- While overall complication rates were low for both routes, the subcostal approach was associated with all major surgical complications.
- An apical approach may be a safer alternative when anatomically feasible.
Objective:
Pericardiocentesis is a life-saving procedure associated with a small, but significant, risk of major complication. An apical or subcostal approach may be used, although the relative complication rates are not reported. In modern practice, an increasing proportion of pericardial effusions occur as a result of catheter-laboratory related complications. This study examines current practice and analyzes the complications of pericardial drainage according to the route of approach.
Design:
Historical cohort study.
Setting:
Four Oxfordshire hospitals, including the John Radcliffe Hospital, a tertiary referral center.
Patients:
Local databases were searched to identify percutaneous pericardiocenteses carried out between November 2002 and October 2009.
Results:
A total of 188 pericardiocenteses were performed in 163 patients. Malignancy (55; 33.7%) and catheter-based cardiac procedures (45; 23.9%) were the most common causes of pericardial effusions requiring drainage. 50.0% of all pericardiocenteses were performed in patients who had received anticoagulant or antiplatelet agents the same day. This rose to 93.7% in patients whose effusions occurred as a complication of a catheter-based procedure. Nine complications occurred during the study period, giving an overall complication rate of 4.8%. Six of the complications occurred via the subcostal route and all 4 complications requiring surgery occurred via the subcostal route.
Conclusion:
The numbers of iatrogenic pericardial effusions occurring as a complication of catheter-based procedures mean that a significant proportion of pericardiocenteses are being performed in anticoagulated patients. This may alter the risk profile. Although complication rates were low for both routes, all major complications requiring surgery occurred via the subcostal approach. These data suggest an apical approach may be preferable where practical.
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