Pericardiocentesis Versus Surgical Pericardiotomy for Malignant Pericardial Effusion: A Systematic Review and...

To compare the effectiveness and safety of pericardiocentesis versus surgical pericardiotomy in managing malignant pericardial effusion (MPE). We searched PubMed, Embase, and Cochrane databases for studies comparing pericardiocentesis with surgical pericardial window in patients with MPE. We computed mean differences (MDs) for continuous endpoints and odds ratios (ORs) for binary outcomes, with 95% confidence intervals (CIs). Trial registry: International Prospective Register of Systematic Reviews; Nº: CRD42024572468. A total of 12 studies comprising 3,721 patients were included in this meta-analysis. There was a significant increase in re-accumulation of pericardial effusion in patients undergoing pericardiocentesis (OR 3.81; 95% CI 1.99-7.31). However, there were no significant difference between groups for in-hospital mortality (OR 0.99; 95% CI 0.68-1.46), bleeding (OR 0.05; 95% CI 0.00-2.18), atrial fibrillation (OR 0.50; 95% CI 0.05-5.12), paradoxical hemodynamic instability (OR 0.67; 95% CI 0.32-1.38), and length of stay (MD -0.93; 95% CI -6.17, 4.31). Significant heterogeneity was observed in the length of hospital stay outcome (I² = 79%). Additionally, the included studies had a moderate risk of bias. Pericardiocentesis was associated with an increase in re-accumulation of pericardial effusion compared with surgical pericardial window in patients with MPE. However, there was no significant difference between groups for in-hospital mortality, bleeding, atrial fibrillation, paradoxical hemodynamic instability, and length of stay.

The online version contains supplementary material available at 10.1007/s13193-025-02235-6.