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Efficacy and safety of thoracoscopic pericardial window in patients with
pericardial effusions: a single-center case series
#MMPMID27297223
Sakanoue I
; Hamakawa H
; Okubo Y
; Minami K
; Miyamoto E
; Shomura Y
; Takahashi Y
J Cardiothorac Surg
2016[Jun]; 11
(1
): 92
PMID27297223
show ga
BACKGROUND: Pericardial effusion (PE) is a common finding in patients who had
chronic cardiac failure, who had undergone cardiac surgery, or who had certain
other benign and malignant diseases. PE ranges in severity from mild,
asymptomatic effusions to cardiac tamponade. Although a thoracoscopic pericardial
window (TPW) is a minimally invasive surgical option for patients with PE, there
are few published data regarding the outcomes of TPW for PE. We investigated the
contribution of the TPW to the treatment of PEs that are recurrent or difficult
to drain percutaneously. METHODS: We conducted a retrospective chart review of
the indications for TPW that included data on preoperative, intraoperative, and
postoperative variables; morbidity; recurrence; and survival. Fourteen
consecutive patients with PE that was recurrent or difficult to drain
percutaneously and who underwent treatment with a TPW were enrolled in this
study. Trocars for passage of the thoracoscope and surgical instruments were
introduced through two or three incisions. Mini-thoracotomy was also performed in
patients with hemopericardium and loculated fibrinous effusions. All patients
were evaluated by face-to-face interviews, transthoracic echocardiography (TTE),
and chest radiography 3-6 months after the TPW was obtained. RESULTS: The mean
age of the patients was 70 years (range 28-83 years). The operative time was
72.1?±?29.5 min. Six patients had undergone open heart surgery during the month
prior to their presentation with PE. No intraoperative or postoperative
complications occurred, although PE had recurred in one patient. Two patients
died of malignant disease several months after the TPW. The cardiothoracic ratio
(determined on chest radiographs) and the ejection fraction ratio (determined
using TTE) had improved at the 3- and 6-month follow-up evaluations (p?
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