Thoracoscopic partial pericardiectomy in the diagnosis and management of pericardial effusion

Robles, R; Piñero, Antonio; Luján, Juan; Fernández, José Antonio; Torralba, José Antonio; Acosta, F; Villegas, Manuel; Parrilla, Pascual

doi:10.1007/s004649900337

Cited by 23 publications

(15 citation statements)

References 17 publications

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“…Recurrence rates range between 0% and 33%. Although minimally invasive surgery (video-assisted thoracoscopy) was only used in 3 patients in this series, it seems to have a role in the surgical management of pericardial effusions 12,13,37,38 and its use will probably increase in the future. Other minimally invasive techniques include laparoscopic transabdominal pericardial window 14,15,39 and percutaneous balloon pericardial window.…”

Section: Commentmentioning

confidence: 99%

Ten-Year Surgical Experience With Nontraumatic Pericardial Effusions

Liberman

Labos²,

Sampalis³

et al. 2005

Arch Surg

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The approach to pericardial window in patients with nontraumatic pericardial effusion impacts outcome. Design: Retrospective review and comparison of all cases of pericardial window performed over 10 years. Follow-up was to patient death. Setting: Three hospitals performing cardiothoracic surgery at a single university. Patients: All patients in whom pericardial window was performed for nontraumatic pericardial effusion. Main Outcome Measures: Outcomes associated with the subxyphoid approach to pericardial window were compared with those associated with the transthoracic approach. The primary outcome was postsurgical recurrence of pericardial effusion. Secondary outcomes included operative time, intraoperative and postoperative complications, in-hospital mortality, hospital and intensive care unit lengths of stay, and days between surgery and death. Results: Over 10 years, there were 342 patients with procedural codes for pericardial window in the medical record databases of 3 hospitals performing cardiothoracic surgery at 1 university center. One hundred fifty-one patients were excluded because the operation was performed for trauma, postoperative tamponade, or pericardial biopsy without effusion. The results are, therefore, based on the remaining 191 procedures. The subxyphoid approach was used in 78 patients, and the transthoracic approach in 113 patients. Patients were well matched for age (P=.31), sex (P=.05), preoperative tamponade (P =.08), and comorbidities (PϾ .05). No differences were observed between the 2 approaches in terms of recurrence of effusion, operative time, overall intraoperative or postoperative complications, and hospital or intensive care unit lengths of stay. In-hospital mortality was significantly greater in the subxyphoid group (27 of 78 vs 18 of 113 patients; P =.003). Conclusions: Over 10 years, there were 191 pericardial windows performed for nontraumatic pericardial effusions. The subxyphoid and transthoracic approaches were well tolerated by patients, required short operative times, and resulted in similar rates of overall postoperative complications and intensive care unit and hospital lengths of stay. Recurrence rates were low with both procedures.

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Section: Commentmentioning

confidence: 99%

Ten-Year Surgical Experience With Nontraumatic Pericardial Effusions

Liberman

Labos²,

Sampalis³

et al. 2005

Arch Surg

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“…Pericardial effusions may be related to other aetiologies requiring histological or bacteriological verification such as infections, post-irradiation sequelae, uraemia, collagen vascular diseases and myocardial infarction. In a substantial number of patients, concurrent pleural pathology is present requiring the establishment of simultaneous pleuropericardial diagnosis [3][4][5][6]. Approximately half of the patients suffering from pericardial effusions present with symptoms of cardiac tamponade [7,8].…”

Section: Introductionmentioning

confidence: 99%

“…Tel. : +41 31 6322330; fax: +41 31 sufficient size with simultaneous assessment of concomitant pleural pathology [3][4][5][6][9][10][11][12].…”

Section: Introductionmentioning

confidence: 99%

Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions

Geissbühler

Leiser

Fuhrer

et al. 1998

European Journal of Cardio-Thoracic Surgery

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“…As a result, open thoracic approaches for pericardiectomy are preferred because they provide better surgical exposure and incision (Dupre et al, 2001;Vistarini et al, 2015). These techniques are performed by median sternotomy, subxiphoideal and left or right lateral thoracotomy (Hardy et al, 1992;Robles et al, 1997;Vistarini et al, 2015). Because thoracotomy has potential for substantial postoperative problems, including postoperative pain, hypoventilation, hypothermia, acid-base SOC 2017SOC , 68(3) ΠΕΚΕ 2017 may cause a form of myocarditis that is induced by operative trauma during visceral pericardiectomy (Wood et al, 2002).…”

Section: Discussionmentioning

confidence: 99%

Comparison of early stage electrocardiographic, echocardiographic and histopathologic results of partial pericardiectomy and thoracoscopic pericardial window techniques in an animal model

Salcı

Kocatürk

İpek

et al. 2018

J Hellenic Vet Med Soc

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This study aimed to compare early stage electrocardiographic (ECG), echocardiographic (ECHO) and histopathologic results of the pericardial surgery techniques. Partial pericardiectomy by lateral thoracotomy and thoracoscopic pericardial window techniques was performed under general anesthesia in goats (n=6), which were separated into two groups; partial pericardiectomy was performed in group I (GRI) (n=3) and thoracoscopic pericardial window was performed in group II (GRII) (n=3). ECG and ECHO examinations were performed pre- and postoperatively on days 1, 7 and 30. All experimental animals were sacrificed at the end of day 30 and macroscopic investigations were performed. Histopathological examinations were performed on the lung, visceral pleura, epicardium and myocardial tissues. ECG findings included sinus tachycardia, small complex QRS and T wave peak on day 1 in both groups., The left atrial and ventricular diameters as well as the stroke volume were lower on the 1st postoperative day in both groups. The stroke volume was lower on postoperative days 1 and 30 in GRII. The observed ejection fraction was lower in GRII and higher in GRI on postoperative day 30 compared with their baselines. Macroscopic and histopathological findings of the lung and heart tissues were more severe in GRI, but there was no meaningful variation in the epicardium or visceral pleura. There was no significant difference in the histopathological results between the groups. Although the thoracoscopic pericardial window technique seem less traumatic and better tolerated than partial pericardiectomy, our ECHO and histopathologic results indicate that both techniques can safely be performed by surgeons according to the pericardial disease indication.

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Thoracoscopic partial pericardiectomy in the diagnosis and management of pericardial effusion

Abstract: The thoracoscopic management of pericardial effusions is a simple and effective technique that allows us to create a large pericardial window that drains the effusion definitively, determines its etiology, and explores and treats coexisting pleural lesions, all without recurrences.

Cited by 23 publications

References 17 publications

Ten-Year Surgical Experience With Nontraumatic Pericardial Effusions

Ten-Year Surgical Experience With Nontraumatic Pericardial Effusions

Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions

Comparison of early stage electrocardiographic, echocardiographic and histopathologic results of partial pericardiectomy and thoracoscopic pericardial window techniques in an animal model

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