Clinical and Echocardiographic Characteristics of Patients With Cardiac Tamponade and its Survival Prognostic Factors

Document Type: Original Article

Authors

1 Department of Cardiovascular Surgery, Seyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IR Iran.

2 Department of Cardiology, Seyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IR Iran.

3 General Physician, Urmia University of Medical Sciences, Urmia, IR Iran.

4 Department of Cardiac Anesthesiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, IR Iran.

Abstract

Background: Cardiac tamponade nearly always requires urgent intervention, but the optimal management of pericardial effusion is still controversial. The aim of our study was to introduce the profile and treatment results of patients with tamponade in our referral heart center.
Methods: From November 2010 to November 2014, our retrospective study was performed on 220 patients with tamponade. All the clinical and echocardiographic findings of the patients, as well as their operative and follow-up data, were recorded and analyzed.
Results: The overall prevalence of tamponade relative to the entire study population undergoing heart surgery was 8.5%. There were 106 men and 114 women at a mean age of 55.5 years (range = 5–99). The most common causes of tamponade were cardiac diseases (21%), malignancy (20.4%), unknown (20.4%), chronic renal failure (15%), and post-cardiac surgery complications (10.5%). The approaches for pericardial effusion drainage were the subxiphoid approach (97.7%), mini-thoracotomy (1.4%), and percutaneous pericardiocentesis (0.9%). The intraprocedural mortality rate was zero, the mortality rate during hospital stay was 4.5%, and the recurrence rate was 9.1%. Patients with primary sanguineous pericardial effusion, malignant etiologies of tamponade, and malignant pericardial effusion had significantly poor survival. The survival rates at 1 month, 1 year, 2 years, and 3 years were 87.1%, 67.7%, 64.5%, and57.2%, respectively.
Conclusions: We found an association between left pleural effusion and small amounts of pericardial effusion, hence the necessity of more attention in the echocardiographic evaluation of these patients. The subxiphoid approach for pericardial effusion drainage is a safe and simple procedure associated with relatively lower postoperative complications, mortality, and recurrence rate. Sanguineous pericardial effusion is concomitant with poor prognoses.

Keywords


1. Mirhosseini SM, Fakhri M, Mozaffary AH,
Lotfaliany M , Behzadnia N, Ansari Aval Z,
et al. Risk factors affecting the survival rate
in patients with symptomatic pericardial
effusion undergoing surgical intervention.
Interactive CardioVascular and Thoracic
Surgery 2013; 16: 495–500.
2. Quraishi AR, Khan AA, Kazmi KA, Najaf
SM, Basir MN, Shafquat A, et al. Clinical
and Echocardiographic Characteristics of
Patients with Significant Pericardial
Effusion requiring Pericardiocentesis. JPMA
2005;55:66
3. Allen KB, Faber LP,Warren WH, Shaar CJ.
Pericardial Effusion: Subxiphoid
Pericardiostomy versus Percutaneous
Catheter Drainage. Ann Thorac Surg 1999;
67:437–40.

4. Motas C, Motas N, Rus O, Horvat T. Left
paraxiphoidian approach for drainage of
pericardial effusions. Interactive
CardioVascular and Thoracic Surgery 2010;
10:4–6.
5. Petcu CP, Droc I. The Efficiency of Surgical
Subxiphoid Pericardial Drainage and
Percutaneous Pericardial Drainage in
Pericardial Effusions Associated with
Cardiac Tamponade. Chirurgia 2013;
108(2): 226-233.
6. Jeon HW, Cho DG, Park JK , Hyun KY,
Choi SY, Suh JH , et al. Prognostic factors
affecting survival of patients with cancerrelated pericardial effusion managed by
surgery. World Journal of Surgical
Oncology 2014, 12:249.
7. Langdon SE, Seery K, Kulik A.
Contemporary outcomes after pericardial
window surgery: impact of operative
technique. Journal of Cardiothoracic Surgery
2016; 11:73.
8. Hamid M, Khan MU, Bashour AC.
Diagnostic Value of Chest X-ray and
Echocardiography for Cardiac Tamponade
in Post Cardiac Surgery Patients. JPMA
2006; 56:104.
9. Wang ML, Liao WB, Bullard MJ, Lin FC,
Lin PJ, Chiang CW, et al. cardiac tamponade
in Taiwan. Jpn Circ J 1997; 61: 767-771.
10. Ekim M, Ekim H. Diagnostic value of the
biochemical tests in patients with purulent
pericarditis. Pak J Med Sci 2014; 30(4):845-
849.
11. Arısoy A, Memiç K, Karavelioğlu Y, Şen F.
Cardiac tamponade as the first clinical sign
of gastric adenocarcinoma: a rare condition.
Arch Turk Soc Cardiol 2014; 42(4):377-379.
12. Laham RJ, Cohen DJ, Kuntz RE, Baim DS,
Lorell BH, Simons M. Pericardial effusion
in patients with cancer: outcome with
contemporary management strategies. Heart
1996; 75: 67–71.
13. Imazio M and Adler Y. Management of
pericardial effusion. European Heart Journal
2013; 34, 16, 1186–1197.
14. Syed FF, Ntsekhe M,Mayosi BM .Tailoring
diagnosis and management of pericardial
disease to the epidemiological setting. Mayo
Clinic Proceedings 2010:85, 9, 866.
15. Golmohammadi M, Mehdizadeh H. Cardiac
Tamponade: The First Manifestation of
Myxedema. RJMS. 2007; 14 (54):139-142.
16. Celik S, Celik M, Aydemir B, Tanrıkulu H,
Okay T , Tanrikulu N. Surgical properties
and survival of a pericardial window via left
minithoracotomy for benign and malignant
pericardial tamponade in cancer patients.
World Journal of Surgical Oncology 2012,
10:123.
17. Larrey DJ. New surgical procedure to open
the pericardium and determine the cause of
fluid in its cavity. Clin Chir 1829; 36: 303.
18. Becit N, U¨ nlu¨ Y, Ceviz M, Koc¸og˘ullari
CU, Koc¸ak H, Gu¨rlertop Y. Subxiphoid
pericardiostomy in the management of
pericardial effusions: case series analysis of
368 patients. Heart 2005; 91: 785–790.
19. Wagner PL, McAleer E, Stillwell E, Bott M,
Rusch VW, Schaffer W et al. Pericardial
effusions in the cancer population:
prognostic factors after pericardial window
and the impact of paradoxical hemodynamic
instability. J Thorac Cardiovasc Surg 2011;
141: 34–8.
20. Mueller XM, Tevaearai HT, Hurni M,
Ruchat P, Fischer AP, Stumpe F et al. Longterm results of surgical subxiphoid
pericardial drainage. Thorac Cardiovasc
Surg 1997; 45: 65–9.
21. Dosios T, Theakos N, Angouras D,
Asimacopoulos P: Risk factors affecting the
survival of patients with pericardial effusion
submitted to subxiphoid pericardiostomy.
Chest 2003, 124:242–246
22. Wang PC, Yang KY, Chao JY, Liu JM,
Perng RP and Yen SH: Prognostic role of
pericardial fluid cytology in cardiac
tamponade associated with non-small cell
lung cancer. Chest 2000, 118:744–749.