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AbstractThe optimal management of effusive pericardial disease remainscontroversial. Subxiphoid drainage has been criticized for a highrecurrence rate while transthoracic procedures (window or pericardiectomy)are more invasive operations with greater potential for morbidity. Wecompared subxiphoid (SX group) and transthoracic (TT group) drainage in 131patients (age range from 1 month to 81 years) treated from 1979 to thepresent. The etiology of effusion included cancer (38), uremia (24),infection (27), radiation (9), and other (33) causes. The two groups hadsimilar age and sex distribution, etiology, and fluid volume. There was nodifference in the operative mortality between the two groups (SX 15%, TT13%, p = NS). Patients undergoing thoracotomy for treatment of effusivepericardial disease had a higher incidence of respiratory complications asdefined by the presence of pneumonia, pleural effusion, prolongedventilation, and need for reintubation (SX 11%, TT 35%, p less than 0.005).This may account, in part, for the longer mean hospital stay intransthoracic group (14.4 vs. 11.4 days). Nine patients were lost tofollow-up after hospital discharge. The remaining 104 hospital survivorswere followed for between 1 month and 11 years (mean 34 months, cumulativeof 297 patient years). Three patients in each group experienced fluidrecurrence and all but one were successfully treated by needle aspirationor percutaneous catheter placement. Following discharge, no patientrequired reoperation for effusive or constrictive pericardial disease ordied from tamponade. There were no significant differences in 5-yearactuarial survival (SX 54%, TT 49%) or actuarial freedom from recurrence(SX 89%, TT 93%).(ABSTRACT TRUNCATED AT 250 WORDS)
European Journal of Cardio-Thoracic Surgery – Oxford University Press
Published: Feb 1, 1991
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