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Published on: June 12, 2021
Systematic review of percutaneous interventions for malignant pericardial effusion
Sohaib A Virk1, David Chandrakumar1, Claudia Villanueva2
1The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia.
Abstract:
The present systematic review assessed the safety and efficacy of percutaneous interventions for malignant pericardial effusion (MPE), with primary endpoint of recurrence of pericardial effusion. Electronic searches of six databases identified thirty-one studies, reporting outcomes following isolated pericardiocentesis (n=305), pericardiocentesis followed by extended catheter drainage (n=486), pericardial instillation of sclerosing agents (n=392) or percutaneous balloon pericardiotomy (PBP) (n=157). Isolated pericardiocentesis demonstrated a pooled recurrence rate of 38.3%. Pooled recurrence rates for extended catheter drainage, pericardial sclerosis and PBP were 12.1%, 10.8% and 10.3%, respectively. Procedure-related mortality ranged from 0.5-1.0% across the percutaneous interventions. Although isolated pericardiocentesis can safely deliver immediate symptomatic relief, subsequent catheter drainage or sclerotherapy are required to minimize recurrence. PBP has been shown to be highly effective and may be particularly useful in managing recurrent effusions. Ultimately, the choice of intervention must be based on the clinical status of patients, their underlying malignancy and the expertise available.
Insights
For malignant pericardial effusion (MPE), isolated pericardiocentesis offers relief but has high recurrence. Extended drainage, sclerosis, or percutaneous balloon pericardiotomy (PBP) significantly reduce MPE recurrence.
Area of Science:
- Cardiology
- Interventional Radiology
- Oncology
Background:
- Malignant pericardial effusion (MPE) poses significant risks.
- Percutaneous interventions are common treatments for MPE.
Purpose of the Study:
- To systematically review the safety and efficacy of percutaneous interventions for MPE.
- To compare recurrence rates and mortality across different procedures.
Main Methods:
- Systematic review of 31 studies.
- Included interventions: isolated pericardiocentesis, extended catheter drainage, pericardial sclerosis, and percutaneous balloon pericardiotomy (PBP).
- Primary endpoint: recurrence of pericardial effusion.
Main Results:
- Isolated pericardiocentesis had a 38.3% recurrence rate.
- Extended drainage (12.1%), pericardial sclerosis (10.8%), and PBP (10.3%) showed significantly lower recurrence rates.
- Procedure-related mortality was low (0.5-1.0%) across interventions.
Conclusions:
- While isolated pericardiocentesis provides initial relief, it requires further intervention to prevent MPE recurrence.
- Extended catheter drainage, pericardial sclerosis, and PBP are effective in minimizing recurrence.
- PBP is highly effective, especially for recurrent effusions. Treatment choice depends on patient status, malignancy, and available expertise.
