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Risk Factors Affecting the Survival of Patients With Pericardial Effusion Submitted to Subxiphoid Pericardiostomy^*

^* From the Division of Thoracic Surgery (Drs. Dosios and Angouras), Athens University Medical School; and Department of Cardiothoracic Surgery (Drs. Theakos and Asimacopoulos), Henry Dunant Hospital Athens, Greece.

Correspondence to: Theodosios Dosios, MD, 2 Chatzigianni Mexi Str, 11528, Athens, Greece; e-mail: dosiosth{at}internet.gr

Study objectives: Surgical subxiphoid drainage of the pericardial cavity has been established as a safe and effective method of treatment of pericardial effusion; however, the risk factors affecting survival of these patients have not been clarified. The aim of this study was to investigate the risk factors affecting the short-term and long-term survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy.

Design: Retrospective study.

Patients: The records of all patients who underwent subxiphoid pericardiostomy for treatment of pericardial effusion from January 1991 to December 2001 were reviewed. According to underlying pathology the patients were classified into four groups: (1) hematologic malignancies (n = 17); (2) other malignant diseases (n = 29); (3) AIDS (n = 5); and (4) other benign diseases (n = 53). Multivariate Cox regression analysis was used to test the relationship of short-term and long-term survival to age, sex, cardiac tamponade, pericardial malignant invasion, postoperative low cardiac output syndrome (PLCOS), and underlying pathology.

Results: There were 104 patients (59 men) with a mean age of 53.6 years (range, 13 to 85 years). Follow-up was complete in 99 patients (95.2%) for a mean of 23.9 months (range, 0 to 92 months). Overall 30-day mortality was 16.3%, while operation-related mortality was 4.8%. The underlying disease was the main risk factor for short-term and long-term survival (p < 0.00001), while PLCOS was a major predictor of early mortality (p = 0.029). Patients with AIDS showed the worst prognosis. On the contrary, patients with hematologic malignancies presented significantly longer survival compared to all other patients with malignant diseases (p < 0.05).

Conclusions: The underlying disease was the main risk factor for short-term and long-term survival, while PLCOS was a major predictor of early mortality. The prognosis of AIDS patients with pericardial effusion was grave; therefore, surgical intervention in such patients should be reevaluated. Patients with hematologic malignancies had significantly longer survival compared to all other patients with malignant diseases.

Key Words: AIDS • hematologic malignancy • low cardiac output syndrome • pericardial effusion • risk factors

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