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A Comparison Between the Subxyphoid and Transthoracic Approaches to Pericardial Window

Moishe Liberman, MD; Chris Labos; John S. Sampalis, PhD; Nathan M. Sheiner, MD; David S. Mulder, MD

Arch Surg. 2005;140:191-195.

Hypothesis  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 (P > .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.

Author Affiliations: Departments of Surgery (Drs Liberman, Sampalis, and Mulder and Mr Labos) and Clinical Epidemiology (Drs Liberman and Sampalis), Montreal General Hospital, McGill University Health Center; and Department of Surgery, Sir Mortimer B. Davis Jewish General Hospital, McGill University (Dr Sheiner), Montreal, Quebec.

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