Pericardioperitoneal shunt: an alternative treatment for malignant pericardial effusion

The treatment of 37 consecutive cases of symptomatic malignant pericardial effusion over a period of 13 years was retrospectively analyzed. The most common diagnoses were lung cancer (59%) and breast cancer (11%). In the most recent 4 patients, the Denver pleuroperitoneal shunt was used to drain the pericardial effusion into the peritoneal cavity. In each case, the procedure was performed under local anesthesia, and the patient was discharged 2 to 4 days later without complications. Three of the patients subsequently died of the disease process without evidence of cardiac failure or tamponade during 6-month follow-up. The more traditional means of pericardial drainage, the subxiphoid approach (14 patients) and the anterior thoracotomy approach (19 patients), were associated with higher postoperative morbidity (21% and 53%, respectively) and mortality (7% and 42%, respectively). Because of the small number of patients treated by pericardioperitoneal shunting, a significant difference was demonstrated only in the length of hospital stay (shunt, 2.8 +/- 0.5 days; subxiphoid, 11.2 +/- 4.6 days; thoracotomy, 14.9 +/- 6.1 days). Median survivals were essentially the same (shunt, 3.5 months; subxiphoid, 2.7 months; thoracotomy, 1.2 months). It is apparent that the pericardioperitoneal shunt, although a much simpler procedure, can accomplish similar palliation effectively in the treatment of malignant pericardial effusion.