International Society For Minimally Invasive Cardiothoracic Surgery

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Minimal Subxiphoid Access:a Valid Technique For Treatment And Diagnosis Of Pericardial Effusion
Mattia Scognamiglio1, Luigi Chiariello1, Maria Cristina Conti2, Ahmed Desoky1.
1Clinica Mediterranea spa, Napoli, Italy, 2Clinica Sanatrix, Napoli, Italy.

Background Pericardial effusion, beside being a complication of cardiac surgery, may be caused by renal impairment, infections, neoplasms or autoimmune diseases. As it is not simple to diagnose its etiology, pericardial drainage is often necessary for both therapeutic and diagnostic purposes. The target of this study is to demonstrate the safety, simplicity and usefulness of subxiphoid drainage. Methods Between September 1st, 2015 and September 30th, 2018, 12 patients underwent subxiphoid drainage, 7 patients after a failed pericardiocentesis. 2 patients with late pericardial effusion after cardiac surgery, 10 with pericardial effusion of an unknown origin. 6 patients underwent emergency drainage. All procedures were performed in awake patient without intubation. After Xylocaine local anesthesia, an 3 cm incision was performed above the xyphoid process. Once the pericardium was opened, liquid samples were sent for chemical-physical, cytological and bacteriological examination. Also, It was always possible to send a fragment of pericardium for histological examination. A small drainage was placed and wound closed. Results No patient died due to the procedure, no patient required intubation or intensive care stay. All patients were discharged 48 hours after the procedure. Excluding cardiac surgery patients, the etiology was uremic in 2 of patients, infectious/viral in 2, malignant in 3, idiopathic in the rest of cases. No patient had a recurrence of pericardial effusion after 30 days. Conclusions Subxiphoid pericardial drainage is a simple and safe procedure, even in patients undergoing cardiac surgery in the past, where pericardiocentesis could be difficult and dangerous. It does not require intubation of the patient and above all no need for long hospital stay. It allows to send pericardial portions useful in the differential diagnosis of tumor pathology.

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