Comparative study of left anterior thoracotomy versus vats in management of pericardial effusions

ABSTRACT

The aim of this study is to compare the outcome and results of VATS versus left anterior conventional thoracotomy in the management of pericardial effusions and creation of pericardial window. Between March 2002 and February 2006, nineteen patients with proved pericardial effusions were included in this study. They were claimed to have pericardial effusions by chest roentgenogram, echocardiography and chest CT. The patients were divided into 2 groups, group I [Thoracotomy group] and group II [VATS group]. Group I patients [thoracotomy group] included 11 patients, and Group II patients [VATS group] included 8 patients. Thoracotomy or VATS was performed for evacuation of pericardial effusions, creation of pericardial window and sending the taken biopsies of both the pericardium and fluid for cytological pathological and histological examinations. There was no statistical significant difference between the man ages of both groups, as the mean age of the thoracotomy group patients was 47 +/- 7 years, while it was 45.5 +/- 7 years for the VATS group patients. Eight patients [73%] of group I and 6 patients [75%] of group II had symptoms [chest pain or/and dyspnea]. Preoperative pericardiocentesis was done in 6 patients [55%] in thoracotomy group and another 6 patients [75%] in VATS group. There was statistical significant difference [P-value 0.05] between the thoracotomy group patients and the VATS group patients in the mean operative time [52 + 6 minutes VS 44 +/- 3 minutes respectively], and, mean volume of analgesics given in the first 24 hours postoperatively [227 +/- 15 mg VS 206 +/- 14 mg respectively], in the mean ICU stay [5.7 +/- 1 days VS 4 +/- 1 days, respectively], and in the mean hospital stay [10 +/- 1 day VS 6 +/- 1 days, respectively] postoperatively. There were no statistical significant difference between the 2 groups of patients in the mean ICT drainage postoperatively [737 +/- 170 mL VS 673 +/- 110 mL respectively], and, mean ICT period postoperatively [3.7 +/- 1 days VS 3.75 +/- 1.5 days respectively]. Biopsies proved malignancies in 5 patients [45%] in group I, and in 4 patients [50%] in group II. Complications occurred more in thoracotomy group of patients than that of VATS group of patients. Mortality [9% VS 0%, respectively], wound infection [9% VS 0%, respectively], and recurrence [18% VS 25%, respectively]. Although VATS with the creation of pericardial window requires general anesthesia and single lung ventilation, it is a safe, minimally invasive technique that allows for effective pericardial drainage as well as diagnostic tools. It carries less morbidity and mortality than that of conventional left anterior thoracotomy. We suggest that it should be used in carefully selected patients with proper indications