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Differences in outcomes between surgical pericardial window and pericardiocentesis in children with
Joshua T Fields1, Conor P O'Halloran2, Paul Tannous2
1College of Medicine, Medical University of South Carolina, Charleston, SC, USA.
Insights
Surgical pericardial window and pericardiocentesis are equally effective for draining pericardial effusions in children with postpericardiotomy syndrome. Both procedures show similar safety and resource utilization, offering comparable outcomes for pediatric patients.
Area of Science:
- Pediatric Cardiology
- Cardiac Surgery
- Thoracic Surgery
Background:
- Postpericardiotomy syndrome can lead to hemodynamically significant pericardial effusions in children after cardiac surgery.
- Drainage of these effusions is often necessary, with surgical pericardial window and pericardiocentesis being the primary interventions.
- The optimal method for effusion drainage in this pediatric population remains undetermined.
Purpose of the Study:
- To compare the efficacy, safety, and resource utilization of surgical pericardial window versus pericardiocentesis for managing pericardial effusions in children with postpericardiotomy syndrome.
- To evaluate the outcomes of these drainage procedures in a pediatric cohort.
- To provide data to inform the optimal approach for effusion management.
Main Methods:
- Retrospective observational study conducted at two pediatric cardiac centers.
- Inclusion of 42 children under 18 years old who developed postpericardiotomy syndrome post-cardiac surgery (2014-2021).
- Comparison of outcomes between 32 patients who underwent pericardial window and 10 patients who underwent pericardiocentesis.
Main Results:
- Patients undergoing pericardial window presented with postpericardiotomy syndrome earlier (median 7.5 days vs. 14.5 days, P=0.03) and had earlier intervention (median 8 days vs. 16 days, P=0.16).
- No patient required subsequent drainage procedures after initial intervention.
- No significant differences observed in pericardial tube duration, complications, intensive care, or hospitalization days between the two groups.
Conclusions:
- Pericardial window and pericardiocentesis demonstrate similar efficacy and safety for draining pericardial effusions in pediatric postpericardiotomy syndrome.
- Both procedures exhibit comparable resource utilization and patient outcomes.
- These findings suggest that either approach can be considered for effusion drainage in this patient group.
Abstract:
Children with postpericardiotomy syndrome may develop hemodynamically significant pericardial effusions warranting drainage by surgical pericardial window or pericardiocentesis. The optimal approach is unknown. We performed a retrospective observational study at two pediatric cardiac centers. We included 42 children aged <18 years who developed postpericardiotomy syndrome following cardiac surgery between 2014 and 2021. Thirty-two patients underwent pericardial window and 10 underwent pericardiocentesis. Patients in the pericardial window group presented with postpericardiotomy syndrome sooner than those who underwent pericardiocentesis (median 7.5 days vs. 14.5 days, P = 0.03) and tended to undergo earlier intervention (median 8 days vs. 16 days, P = 0.16). No patient required subsequent drainage. There were no differences between groups in days of pericardial tube duration (median 4 days), complications, and subsequent days of intensive care or hospitalization. For children with postpericardiotomy syndrome with a pericardial effusion warranting drainage, these data suggest that pericardial window and pericardiocentesis have similar efficacy, safety, and resource utilization.
