Comparison between subxiphoid approach and left thoracotomy in surgical treatment of malignant pericardial effusion - The experience of Taipei veterans general hospital

There are several methods to release pericardial tamponade or pericardial effusion. In this study, we evaluated two different surgical approaches: subxiphoid pericardial drainage and left anterior thoracotomy. From 1/1993 to 5/1998, 22 patients (16 male and 6 female, aged 28-81 years) with malignant pericardial effusion with or without cardiac tamponade were treated with surgical intervention. Among them, 12 patients were treated with the subxiphoid approach and 9 patients with the thoracotomy approach. Another one patient received thoracotomy followed by subxiphoid approach because of recurrent pericardial effusion. The underlying etiology of malignancy for pericardial effusion was similar between the two groups. Symptoms were partially relieved by pericardiocentesis before operation in 7 patients. Though there were no deaths or major complications attributable to surgery itself, 4 patients died of underlying diseases within one month after operation. The overall 30-day mortality was 4/22. To evaluate the effect of surgery, 16 patients were followed up with echocardiography at least 2 weeks after removal of drainage tube. The cumulative effusion-free rate was 100% (10/10) in patients with the subxiphoid approach and 50% (3/6) in patients with the thoracotomy approach (p = 0.063). Compared with left anterior thoracotomy, subxiphoid pericardial drainage seems a more efficient treatment, with low morbidity, for malignant pericardial effusion.