Prof. Ibrahim Mohamed Reda kasb :: Publications:

Objectives: To evaluate the therapeutic yield of pericardiotomy for management of malignant pericardial effusion (MPE) comparing the subxiphoid versus mini-thoracotomy approaches. Patients & Methods: The study included 45 patients; 31 males and 14 females with mean age of 49.4±11.3 years. Thirteen patients were asymptomatic, 24 patients had varying degrees of tamponade and 8 patients had severe tamponade. Echocardiography detected massive PE in 17, severe PE in 21 and moderate PE in 7 patients. CT imaging detected pericardial mass in 6 patients and pleural effusion in 15 patients. Thirteen patients had emergency pericardiocentesis. Then, 23 patients had subxiphoid pericardiotomy and bleomycin pericardiodesis, while 22 patients had pericardio-pleural drainage through left mini-thoracotomy. Operative and postoperative (PO) data were analyzed. Results: Mean operative time and total hospital stay were significantly longer with thoracotomy compared to subxiphoid approach. There was significantly higher consumption of PO analgesia with thoracotomy compared to subxiphoid pericardiotomy. Frequency of PO pain, infection and recurrence was significantly higher, while the frequency of PO bleeding was non-significantly higher with thoracotomy compared to subxiphoid approach. No procedure-related mortality was reported. All mortalities were attributed to either underlying primary malignancy or associated other co-morbidities. The 30-days, 6-month and one-year mortality rates were 17.8%, 55.6% and 86.7%, respectively. Six patients (13.3%) survived beyond the 1st PO year. Conclusion: Management of MPE must be individually designed; subxiphoid pericardiotomy is appropriate approach for those unfit for general anesthesia and could be conducted for patients had preliminary pericardiocentesis as a continuation procedure. Pericardiodesis and pericardio-peritoneal drainage significantly reduced recurrent MPE after subxiphoid pericardiotomy. Mini-thoracotomy could be preserved for patients had left pleural effusion and fit for general anesthesia. No procedure-related mortality was reported and postoperative morbidities were minimal.