Management of Cardiac Tamponade: A Comperative Study between Echo-Guided Pericardiocentesis and Surgery-A Report of 100 Patients

Abstract

Background. Cardiac tamponade (CT) represents a life-threatening condition, and the optimal method of draining accumulated pericardial fluid remains controversial. We have reviewed 100 patients with CT at our institution over a five-year period and compared the results of echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis with regard to functional outcomes. Methods. The study group consisted of 100 patients with CT attending Yuzuncu Yil University from January 2005 to January 2010 who underwent one of the 3 treatment options (echo-guided pericardiocentesis, primary surgical treatment, and surgical treatment following pericardiocentesis). CT was defined by clinical and echocardiographic criteria. Data on medical history, characteristics of the pericardial fluid, treatment strategy, and follow-up data were collected. Results. Echo-guided pericardiocentesis was performed in 38 (38%) patients (Group A), primary surgical treatment was preformed in 36 (36%) patients (Group B), and surgical treatment following pericardiocentesis was performed in 26 (26%) patients (Group C). Idiopathic and malignant diseases were primary cause of tamponade (28% and 28%, resp.), followed by tuberculosis (14%). Total complication rates, 30-day mortality, and total mortality rates were highest in Group C. Recurrence of tamponade before 90 days was highest in Group A. Conclusions. According to our results, minimal invasive procedure echo-guided pericardiocentesis should be the first choice because of lower complication and mortality rates especially in idiopathic cases and in patients with hemodynamic instability. Surgical approach might be performed for traumatic cases, purulent, recurrent, or malign effusions with higher complication and mortality rates.