Pericardial-Peritoneal Window with a Subxiphoid Approach under Local Anesthesia for Refractory Pericardial Effusion / 日本心臓血管外科学会雑誌

ABSTRACT

Background: Pericardial effusion is a common finding with a wide spectrum of etiologies. Surgical management is recommended for a patient with intractable pericardial effusion which is resistant to medical treatment and causes cardiac tamponade. Various surgical approaches for pericardial effusion have been reported, for example thoracotomy, open abdominal surgery, video-assisted thoracic surgery, laparoscopic surgery, and subxiphoid approach. Objectives: We report the results of pericardial-peritoneal window using a subxiphoid approach under local anesthesia for refractory pericardial effusions. Methods: Five patients who underwent pericardial-peritoneal window surgery for refractory pericardial effusion between April 2011 to June 2022 were included in this study. The age of the patients was 61±14 years, and one (20%) was male. The comorbidities were four cases of autoimmune disease (two cases of scleroderma, one case of systemic lupus erythematosus, and one case of IgG4-related disease) (80%) and two cases of follicular lymphoma (40%). For comorbidities, steroids were administered in 2 patients (40%) and immunosuppressive drugs in 4 patients (80%). Colchicine was administered in 3 patients (60%) to treat pericardial effusions. Pericardiocentesis had been performed in 4 patients (80%) prior to surgery. Under local anesthesia in the supine position, a small incision was made at lower end of the sternum and the xiphoid process was resected. A pericardial-peritoneal window of more than 40 mm in diameter was created. In the past, only the diaphragmatic window was opened, but recently the diaphragmatic window and the anterior aspect of the pericardial sac membrane have been resected continuously to open the pericardial sac widely. Results: The operative time was 36±15 min. One complication was postoperative hemorrhage. There were no operative deaths or hospital deaths. Preoperative colchicine was discontinued in all patients after surgery. The mean postoperative follow-up was 2.7 years (0.5-5.9）, and no reaccumulation of pericardial effusion was observed in any of the patients. Conclusions: The pericardial-peritoneal window with a subxiphoid approach can be safely performed under local anesthesia, and if the window is created large enough, it could be a minimally invasive and effective treatment for refractory pericardial effusions.