[Surgical treatment results of chronic pericardial tamponade]

To report the efficacy of chronic pericardial effusion treatment with pericardial window creation through video-assisted thoracoscopic surgery and pericardial drainage through a small subxiphoid incision.

Retrospective analysis of 31 patients after pericardial window creation through video-assisted thoracoscopic surgery (PW group) and 77 patients where pericardial drainage through small subxiphoid incision (PD group) was performed. Echocardiography examinations were performed to document pericardial tamponade and pericardial effusion recurrence.

Length of surgery was 20.5±5.4 minutes in the PD group and 25.8±6.4 minutes in the PW group, p<0.001. Amount of fluid evacuated from pericardium during surgery was 483±191 ml and 521±253 ml in PD and PW groups respectively, p=0.654. Postoperative drainage was maintained longer (4.3±1.4 days vs. 3.2±1.0, p<0.001) and the amount of fluid drained after surgery was higher (497±351 ml vs. 309±231 ml, p=0.031) in the PW group. The amount of pericardial fluid at the end of hospitalization was statistically significantly higher in the PD group compared with the PW group (8.9±4.9 mm vs. 4.9±3.2 mm, p<0.001). Hospital stay was 5.7±2.7 days in the PD group and 6.1±3.4 in the PW group, p=0.112. No patient died during hospitalization period in either group. Mortality within 30 days after surgery was 2.6% in the PD and 3.2% in the PW group (p=0.642). In the PW group there were 4 conversions to right minithoracotomy due to dense pleural adhesions. Pericardial effusion recurrence occurred in 9 patients (12.0%) in the PD group and none was observed (0.0%) in the PW group (p=0.042) within 30 days after surgery.

Pericardial window creation through video-assisted thoracoscopic surgery should be considered the preferred method over pericardial drainage through a small subxiphoid incision for chronic pericardial effusion and pericardial tamponade treatment to reduce the frequency of pericardial effusion reoccurrence.