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Comparison of Pericardiocentesis in Post-Cardiac Surgery and Nonsurgical Patients with Pericardial Tamponade
Aleks Değirmencioğlu1, Gültekin Karakuş1, Ertuğrul Zencirci1
1Department of Cardiology, School of Medicine, Acibadem University, Istanbul, Turkey.
Insights
The apical approach is a preferred puncture location for pericardiocentesis in post-cardiac surgery tamponade. This method demonstrates prominent procedural success, making it a potential first-line treatment option.
Area of Science:
- Cardiology
- Cardiac Surgery
- Medical Imaging
Background:
- Pericardiocentesis is a procedure to drain fluid from the pericardial sac.
- Optimal puncture site selection for pericardiocentesis after cardiac surgery remains debated.
- Cardiac tamponade can occur due to surgical or non-surgical causes.
Purpose of the Study:
- To compare puncture locations for pericardiocentesis in patients with cardiac tamponade after cardiac surgery versus non-surgical causes.
- To evaluate the efficacy of different puncture sites based on the etiology of pericardial effusion.
Main Methods:
- Retrospective analysis of 68 pericardiocenteses performed between August 2011 and December 2019.
- Patients were categorized into post-surgical and non-surgical cardiac tamponade groups.
- Comparison of clinical profiles, echocardiographic findings, and procedural outcomes.
Main Results:
- Loculated effusions were more frequent in the post-surgical group (48.1% vs. 4.9%).
- Maximal fluid location differed: right ventricular in non-surgical (36.6%) vs. lateral in post-surgical (40.7%).
- Apical drainage was more common in the post-surgical group (77.8% vs. 53.7%).
Conclusions:
- The apical approach is frequently utilized and successful for post-cardiac surgery effusions.
- Apical drainage can be considered the primary treatment choice for post-cardiac surgery tamponade.
- Puncture site selection may vary depending on the cause of pericardial effusion.
Introduction:
There are several approaches for pericardiocentesis. However, there is no definite suggestion about puncture location after cardiac surgery. The purpose of this study is to examine whether there is any difference regarding puncture location during pericardiocentesis in postoperative cardiac tamponade comparing to nonsurgical cardiac tamponade.
Methods:
We retrospectively analyzed patients who had undergone pericardiocentesis from August 2011 to December 2019. Patients were examined in two groups, nonsurgical and postsurgical, based on the etiology of pericardial tamponade. Clinical profiles, echocardiographic findings, and procedural outcomes were identified and compared.
Results:
Sixty-eight pericardiocenteses were performed in this period. The etiology of pericardial effusion was cardiac surgery in 27 cases and nonsurgical medical conditions in 41 cases. Baseline demographic variables were similar between the surgical and nonsurgical groups. Loculated effusion was more common in the postsurgical group (48.1% vs. 4.9%, P<0.001). Maximal fluid locations were different between the groups; right ventricular location was more common in the nonsurgical group (36.6% vs. 11.1%, P=0.02), while lateral location was more common in the postsurgical group (12.2% vs. 40.7%, P=0.007). Apical drainage was more frequently performed in the postsurgical group compared to the nonsurgical group (77.8% vs. 53.7%, P=0.044).
Conclusion:
Apical approach as a puncture location can be used more frequently than subxiphoid approach for effusions occurred after cardiac surgery compared to nonsurgical effusions. Procedural success is prominent in this group and can be the first choice of treatment.
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Description
Excess pleural fluid or air may accumulate in some respiratory disorders in the thoracic cavity. To treat pleural effusion, a physician conducts thoracentesis by carefully piercing the chest wall and entering...