Subxiphoid pericardial window

Fontenelle, Larry J.; Cuello, Leo; Dooley, Byron N.

doi:10.1016/s0002-9610(70)80192-1

Cited by 21 publications

(8 citation statements)

References 8 publications

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“…Over time however, with the advent of modern thoracic surgery, the subxiphoid technique fell into disuse, and the thoracotomy approach with pericardiectomy or creation of a pericardial window became the treatment of choice. Thereafter, in the early 1970’s, the subxiphoid technique became popular once again for the drainage of effusive pericardial disease [ 12 ].…”

Section: Discussionmentioning

confidence: 99%

Contemporary outcomes after pericardial window surgery: impact of operative technique

Langdon

Seery

Kulik

2016

J Cardiothorac Surg

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BackgroundThe optimal window procedure for drainage of a large pericardial effusion has yet to be established. The purpose of this study was to compare the outcomes associated with the subxiphoid and thoracotomy pericardial window techniques, with a focus on perioperative pain and effusion recurrence rates.MethodsA retrospective single-center observational study of all pericardial window operations was performed, with the incision based on surgeon preference. Perioperative data was recorded including time to extubation, narcotic requirements, and the development of a recurrent pericardial effusion.ResultsFrom 2002 to 2015, 179 patients with a large pericardial effusion underwent either a subxiphoid (n = 127) or left anterior mini-thoracotomy (n = 52) pericardial window procedure. Patients (mean age 73.2 years, 56 % female) had a high incidence of previous malignancy (49 %), chronic anticoagulation (34 %), recent infection (26 %), or renal failure (18 %). Cardiac tamponade was present in 50 %, and 12 % had undergone previous pericardiocentesis. Comparing the two techniques, there was no difference in the amount of fluid drained or in the perioperative mortality rate. Postoperatively, patients who had the subxiphoid approach required less time before extubation (P = 0.002) and needed less narcotics within 48 h after surgery (P = 0.0001) compared to thoracotomy patients. However, patients treated with the subxiphoid technique more often developed recurrent moderate or large pericardial effusions (P = 0.02), and there was a trend towards more repeat operations needed (P = 0.15).ConclusionPericardial window surgery via a subxiphoid incision is associated with less postoperative pain and faster time to extubation. However, the thoracotomy approach may be more effective at preventing effusion recurrence and the need for repeat surgery.

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Section: Discussionmentioning

confidence: 99%

Contemporary outcomes after pericardial window surgery: impact of operative technique

Langdon

Seery

Kulik

2016

J Cardiothorac Surg

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“…Approaches advocated include the subxiphoid approach with a pericardial window and a left anterior thoracotomy or median sternotomy with creation of a pericardial window and varying degrees of peri-cardiectomy. 2,3 Excellent results are achievable with all of these methods and the surgical option is often dictated by the etiology of the effusion and the condition of the patient. 4,5 Recently, with the resurgence of interest in thoracoscopy and the advent of video-assisted thoraco-scopic surgery (VATS), drainage of pericardial effusion by thoracoscopic techniques has been described.…”

Section: Discussionmentioning

confidence: 99%

Subxiphoid Approach for Treatment of Pericardial Effusion

Sarıgül

Farsak

Ates

et al. 1999

Asian Cardiovasc Thorac Ann

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Subxiphoid pericardiotomy was the primary treatment in 305 patients with pericardial effusion from January 1984 to June 1996. There were 198 males and 107 females, ages ranged from 15 days to 75 years. The procedure was carried out with local anesthesia and sedation in 263 (86.2%) patients and under general anesthesia in 42 (13.8%). Median drainage was 975.25 ± 48.46 mL in 264 patients with benign effusion and 1131.25 ± 97.48 mL in 41 (13.4%) with malignant disease; cytology was positive in 14 of 38 (36.8%) and pericardial biopsy showed cancer in 12 of 36 (33.3%). Intraoperative complications in 22 patients (7.2%) included cardiac arrest in 12 (3.9%) of whom, 7 (2.3%) died. Overall 30-day mortality was 16.3%; it was 46.3% (19/41) in malignant cases versus 11.7% (31/264) in cases of benign effusion. Follow-up of 234 (91.8%) hospital survivors for 18 ± 3.62 months (range, 2 to 54 months) showed recurrent pericardial effusion needing further intervention in 31 (13.2%) of whom, 8 had cancer and 23 had benign disease. Median survival in benign cases was more than 107 days versus 56 days in malignant cases. Because of its acceptable mortality and morbidity, subxiphoid pericardiotomy is recommend as an initial procedure.

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“…[11,12] Subxiphoid pericardial drainage is the most preferred conventional surgical technique. It was first described by Larrey in 1829, [13] and Fontenelle et al [14] improved the technique. This type of surgery can be performed rapidly under local anesthesia, unlike the pericardial window-opening which requires general anesthesia and longer operation times.…”

Section: Discussionmentioning

confidence: 99%

A comparison of two surgical techniques for symptomatic pericardial effusion after cardiac surgery: subxiphoid open pericardial drainage and lateral thoracotomy

Altintas¹

2014

Turk Gogus Kalp Dama

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Bu çalışmada açık kalp cerrahisi sonrası semptomatik perikardiyal efüzyonlu hastalarda en sık kullanılan iki cerrahi tekniğin sonuçları karşılaştırıldı. Ça lış ma pla nı: Eylül 2004-Eylül 2012 tarihleri arasında, kliniğimizde açık kalp cerrahisi yapılan 14.390 hastanın verileri retrospektif olarak analiz edildi. Toplam 152 hasta bu çalışmaya dahil edildi ve uygulanan tedavi yöntemine göre iki gruba ayrıldı. Subksifoid perikardial drenaj 86 hastaya (%56.6) (grup 1), yan torakotomi ile perikardiyal pencere açılması 66 hastaya (%43.4) uygulandı (grup 2). Bu hastalar içerisinde semptomatik perikardiyal efüzyon gelişmiş olan ve subksifoid perikardiyal drenaj veya yan torakotomi yöntemi ile yeniden eksplore edilen hastalar analiz edildi. Ameliyat sırası veriler, ameliyata bağlı ve 30 günlük hastane mortaliteleri açısından karşılaştırıldı. Bul gu lar: Grup 2'de ameliyat tekniği tam bir başarıya ulaşmışken (%100), grup 1'de başarı oranı %87.2 idi (p<0.003). Lokal anestezi, grup 1'de 73 hastada (%84.9) tercih edildi ve ameliyat süresinin daha kısa olduğu tespit edildi (p<0.001). Grup 1'de dört hasta (%4.7) ameliyat masasında kaybedilmesine rağmen, ameliyata bağlı mortalitede gruplar arasında istatistiksel olarak anlamlı fark bulunamadı (p= 0.133). Grup 1'deki teknik başarısızlığın mortalite oranında artışa yol açtığı tespit edildi (%36.4) (p<0001). So nuç: Subksifoid işlem hızlı ve kolay yapılsa da teknik başarısızlık nadir değildir ve yüksek mortalite oranına sahiptir. Anah tar söz cük ler: Efüzyon; subksifoid; tamponad; torakotomi. Background:This study aims to compare the outcomes of the two most common surgical techniques applied in patients with symptomatic pericardial effusion following open heart surgery. Methods: Between September 2004 and September 2012, we retrospectively analyzed the data of 14,390 patients who underwent open heart surgery in our clinic. A total of 152 patients were included and divided into two groups, according to treatment modality applied. Subxiphoid pericardial drainage was performed in 86 patients (56.6%) (group 1) and pericardial window opening via lateral thoracotomy was performed in 66 patients (43.4%) (group 2). We further analyzed the patients who underwent surgical reexploration due to symptomatic pericardial effusion via lateral thoracotomy or subxiphoid procedure. Perioperative outcomes were compared in terms of operative and 30-day in-hospital mortality. Results: In group 2, operative technique produced a complete success (100%), whereas the success rate was 87.2% in group 1 (p<0.003). Local anesthesia was preferred in 73 patients (84.9%) in group 1 and shorter operation times were observed (p<0.001). Although four patients (4.7%) died in the operating room in group 1, there was no statistically significant difference in operative mortality between the groups (p= 0.133). Technical failure in group 1 led to increased mortality rates (36.4%) (p<0001). Conclusion: Although subxiphoid procedure can be performed rapidly with ease, technical failure is not rare and may be associated wi...

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Subxiphoid pericardial window

Cited by 21 publications

References 8 publications

Contemporary outcomes after pericardial window surgery: impact of operative technique

Contemporary outcomes after pericardial window surgery: impact of operative technique

Subxiphoid Approach for Treatment of Pericardial Effusion

A comparison of two surgical techniques for symptomatic pericardial effusion after cardiac surgery: subxiphoid open pericardial drainage and lateral thoracotomy

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