HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS		QUICK SEARCH:   [advanced] Author: Keyword(s): Year:  Vol:  Page:

This Article Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Add to Personal Folders Download to citation manager Permission Requests Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Piehler, J. M. Articles by Puga, F. J. Search for Related Content PubMed PubMed Citation Articles by Piehler, J. M. Articles by Puga, F. J.

The Journal of Thoracic and Cardiovascular Surgery, Vol 90, 506-516, Copyright © 1985 by The American Association for Thoracic Surgery and The Western Thoracic Surgical Association

ARTICLES

Surgical management of effusive pericardial disease. Influence of extent of pericardial resection on clinical course

JM Piehler, JR Pluth, HV Schaff, GK Danielson, TA Orszulak and FJ Puga

Surgical drainage for effusive pericardial disease is usually accompanied by pericardial resection to obtain tissue for analysis and to lessen the chance of recurrent effusion or late constriction. The purpose of this study was to determine the relationship between the extent of resection and the development of late complications. From 1960 through 1983, 145 patients with pure pericardial effusive disease underwent operative drainage. The effusions were malignant in 72 patients (49.7%) and benign in 73 (50.3%). The patients were divided into three groups according to the extent of resection: complete in 72 patients (49.7%), partial in 36 (24.8%), and window in 37 (25.5%). The 30 day mortality was 19.4% for patients with malignant effusions and 5.5% for those with benign effusions (p less than 0.05). All survivors had immediate improvement in symptoms. The actuarial 1 year survival rate was 23.4% (mean 4.2 months) for patients with malignant disease and 85.6% for patients with idiopathic effusions (p less than 0.001). Survival was not influenced by the extent of resection. Fifteen patients (10.3%) had late constriction or recurrent effusion. Six of these required reoperation, all after having had a window procedure. Actuarial probability of reoperation or late complication was greater with window procedures than other resections, both for all patients (p = 0.0001) and for those with benign disease (p = 0.0001). Transthoracic complete pericardiectomy is the procedure of choice for effusive pericardial disease. Subxiphoid drainage has immediate advantages for selected patients but has a statistically greater chance of late complications.

This article has been cited by other articles:

				J. G.T. Augoustides and W. Y. Szeto Unmasked diabetes insipidus after pericardial drainage and biopsy for pericardial effusion in association with Erdheim-Chester disease J. Thorac. Cardiovasc. Surg., July 1, 2008; 136(1): 217 - 218. [Full Text] [PDF]

				J. L. Gross, R. N. Younes, D. Deheinzelin, A. L. Diniz, R. A. da Silva, and F. J. Haddad Surgical Management of Symptomatic Pericardial Effusion in Patients with Solid Malignancies Ann. Surg. Oncol., December 1, 2006; 13(12): 1732 - 1738. [Abstract] [Full Text] [PDF]

				P. K.H. O'Brien, J. C. Kucharczuk, M. B. Marshall, J. S. Friedberg, Z. Chen, L. R. Kaiser, and J. B. Shrager Comparative Study of Subxiphoid Versus Video-Thoracoscopic Pericardial "Window" Ann. Thorac. Surg., December 1, 2005; 80(6): 2013 - 2019. [Abstract] [Full Text] [PDF]

				M. Liberman, C. Labos, J. S. Sampalis, N. M. Sheiner, and D. S. Mulder Ten-Year Surgical Experience With Nontraumatic Pericardial Effusions: A Comparison Between the Subxyphoid and Transthoracic Approaches to Pericardial Window Arch Surg, February 1, 2005; 140(2): 191 - 195. [Abstract] [Full Text] [PDF]

				Task Force members, B. Maisch, P. M. Seferovic, A. D. Ristic, R. Erbel, R. Rienmuller, Y. Adler, W. Z. Tomkowski, G. Thiene, M. H. Yacoub, et al. Guidelines on the Diagnosis and Management of Pericardial Diseases Executive Summary: The Task Force on the Diagnosis and Management of Pericardial Diseases of the European Society of Cardiology Eur. Heart J., April 1, 2004; 25(7): 587 - 610. [Full Text] [PDF]

				O. Reuthebuch, E. Ecknauer, G. Zund, and M. Turina Total robotic-enhanced pericardiectomy for effusive pericarditis Interactive CardioVascular and Thoracic Surgery, December 1, 2002; 1(2): 102 - 104. [Abstract] [Full Text] [PDF]

				T. Omoto, K. Minami, D. Varvaras, D. Bothig, and R. Korfer Radical Pericardiectomy for Chronic Constrictive Pericarditis Asian Cardiovasc Thorac Ann, December 1, 2001; 9(4): 286 - 290. [Abstract] [Full Text] [PDF]

				T. Ohtsuka, S. Takamoto, J. Nakajima, T. Miyairi, and Y. Kotsuka Minimally invasive limited pericardiectomy: the hybrid approach Ann. Thorac. Surg., October 1, 2000; 70(4): 1429 - 1430. [Abstract] [Full Text] [PDF]

				A. Sarigul, B. Farsak, M S. Ates, M. Demircin, and I. Pasaoglu Subxiphoid Approach for Treatment of Pericardial Effusion Asian Cardiovasc Thorac Ann, December 1, 1999; 7(4): 297 - 300. [Abstract] [Full Text] [PDF]

				K. Geissbuhler, A. Leiser, J. Fuhrer, and H.-B. Ris Video-assisted thoracoscopic pericardial fenestration for loculated or recurrent effusions Eur. J. Cardiothorac. Surg., October 1, 1999; 14(4): 403 - 408. [Abstract] [Full Text] [PDF]

				K. B. Allen, L. P. Faber, W. H. Warren, and C. J. Shaar Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage Ann. Thorac. Surg., February 1, 1999; 67(2): 437 - 440. [Abstract] [Full Text] [PDF]

				T. Ohtsuka, R. K. Wolf, P. Wurnig, and S. E. Park Thoracoscopic Limited Pericardial Resection With an Ultrasonic Scalpel Ann. Thorac. Surg., March 1, 1998; 65(3): 855 - 856. [Abstract] [Full Text] [PDF]

				O. Nugue, A. Millaire, H. Porte, P. de Groote, P. Guimier, A. Wurtz, and G. Ducloux Pericardioscopy in the Etiologic Diagnosis of Pericardial Effusion in 141 Consecutive Patients Circulation, October 1, 1996; 94(7): 1635 - 1641. [Abstract] [Full Text]

				E. A. Maher, F. A. Shepherd, and T. J. R. Todd PERICARDIAL SCLEROSIS AS THE PRIMARY MANAGEMENT OF MALIGNANT PERICARDIAL EFFUSION AND CARDIAC TAMPONADE J. Thorac. Cardiovasc. Surg., September 1, 1996; 112(3): 637 - 643. [Abstract] [Full Text]

				D. G. Hurrell, R. A. Nishimura, S. T. Higano, C. P. Appleton, G. K. Danielson, D. R. Holmes Jr, and A. J. Tajik Value of Dynamic Respiratory Changes in Left and Right Ventricular Pressures for the Diagnosis of Constrictive Pericarditis Circulation, June 1, 1996; 93(11): 2007 - 2013. [Abstract] [Full Text]

				D. W. O. Moores, K. B. Allen, L. P. Faber, S. W. Dziuban, D. J. Gillman, W. H. Warren, R. Ilves, and L. Lininger Subxiphoid pericardial drainage for pericardial tamponade J. Thorac. Cardiovasc. Surg., March 1, 1995; 109(3): 546 - 552. [Abstract] [Full Text]