Does the Thoracoscopic Pericardial Fenestration Side Matter in Patients With Cardiac Tamponade?

Abstract

Introduction: In our study, we aimed to analyze and compare left pericardial fenestration (LPF) with right pericardial fenestration (RPF) in order to reveal the possible advantages or disadvantages in patients with cardiac tamponade (CT).

Patients and Methods: Between January 2011 and December 2018, the medical records of 168 patients referred from the cardiology department of our tertiary central hospital for surgical pericardial fenestration (PF) were reviewed retrospectively. Out of the 168 patients, 54 patients consisting of 31 patients with advanced stage cancer with CT and 23 patients with recurrent CT were included into the study. All patients were provided with percutaneous, echocardiographic-guided drainage prior to video-assisted thoracoscopic surgical PF to avoid instability associated with the induction of general anesthesia and opening of the pericardial window.

Results: There was no significant difference between the two groups in terms of age, sex, body mass index, symptoms, pericardium histology, length of hospital stay, preoperative measurement of pericardial effusion, operative time, preoperative ejection fraction, duration of chest tube drainage, and volume of pericardial fluid drainage. Complication rate was significantly lower in the RPF group. There was no reported ventricular failure in RPF.

Conclusion: After a sweeping highlight of the literature examining the complications of PF, we did not find an eligible reason other than the intervention side for experiencing LV failure in LPF and not in RPF. We hypothesize that to reduce the risk of LV failure, right-sided intervention may be considered in patients with CT who will undergo surgical PF.

Cite this article as: Akkuş M, Seyrek Y. Does the thoracoscopic pericardial fenestration side matter in patients with cardiac tamponade?. Koşuyolu Heart J 2020;23(3):203-7.