PERICARDIOCENTESIS VS SUBXYPHOID PERICARDIOTOMY - COMPARISON OF EFFICACY AND SAFETY

Background:-Comparison of safety and effectiveness of pericardiocentesis versus subxyphoid pericardiotomy in patients with large pericardial effusion (PE) defined as more than 2 cm fluids behind the posterior wall of left ventricle measured by echocardiography. Methods:-A retrospective analysis was performed on consecutive patients with the diagnosis of large PE hospitalized in the Institute of Tuberculosis and Lung Diseases in 2007- 2017. The analysis included 69 patients. The effectiveness of therapy was defined as significant decrease of pericardial fluid volume after procedure. Safety of therapy was assessed by the number of complications like: arrhythmia, respiratory failure requiring respiratory treatment, clinically relevant bleeding, pneumothorax and myocardial injury. In 18 patients pericardiocentesis was performed. In 51 patients pericardiotomy with pericardial biopsy was indicated. Results:-In the periprocedual period, in 51 patients on whom pericardiotomy was performed, 12 events ( 23.5% ) of the pre-specified complications occurred. In 7 patients ( 14% ) paroxysmal atrial fibrillation developed. One patient developed an episode of supraventricular tachycardia. In 2 patients ( 4%), the procedure was complicated by the occurrence of respiratory failure, necessitating treatment with mechanical ventilation. In one patient bleeding complication occurred, requiring transfusion. One patient developed left-sided pneumothorax, requiring drainage. No complications were observed after pericardiocentesis. In both groups the performed procedures were effective in all patients. Conclusions:-Rate of complications was higher in the group of patients treated with pericardiotomy comparing to pericardiocentesis (23.5% vs 0% ).