Percutaneous Interventions for Pericardial Effusion

Study Questions:

What is the safety and efficacy of percutaneous interventions for malignant pericardial effusion (MPE)?

Methods:

Electronic searches were performed using Ovid Medline, Embase, Cochrane Central Register of Controlled Trials (CENTRAL), Cochrane Database of Systematic Reviews (CDSR), ACP Journal Club, and Database of Abstracts of Review of Effects (DARE) from their dates of inception to December 2014. The search terms (“percutaneous” OR “pericardiocentesis” OR “pericardiostomy” OR “pericardiotomy” OR “drainage” OR “catheter” OR “sclerosis”) AND (“malignant” OR “malignancy” OR “neoplastic” OR “cancer”) AND (“pericardial effusion” OR “cardiac tamponade”) were combined as both keywords and MeSH terms. The predetermined primary endpoint was recurrence of pericardial effusion. The primary endpoint of MPE recurrence was pooled for each intervention using the random-effects model.

Results:

Electronic searches of six databases identified 31 studies, reporting outcomes following isolated pericardiocentesis (n = 305), pericardiocentesis followed by extended catheter drainage (n = 486), pericardial instillation of sclerosing agents (n = 392), or percutaneous balloon pericardiotomy (PBP) (n = 157). Isolated pericardiocentesis demonstrated a pooled recurrence rate of 38.3%. Pooled recurrence rates for extended catheter drainage, pericardial sclerosis, and PBP were 12.1%, 10.8%, and 10.3%, respectively. Procedure-related mortality ranged from 0.5–1.0% across the percutaneous interventions.

Conclusions:

The authors concluded that although isolated pericardiocentesis can safely deliver immediate symptomatic relief, subsequent catheter drainage or sclerotherapy is required to minimize recurrence.

Perspective:

This systemic review and pooled analysis suggests that while pericardiocentesis can be safely performed with appropriate imaging guidance to provide immediate symptomatic relief, it has a relatively high recurrence rate compared with combined procedures. The insertion of a pericardial catheter for prolonged drainage or pericardial sclerosis provides more definitive freedom from recurrence, without a significant increase in periprocedural mortality or morbidity. Percutaneous balloon pericardiotomy was also shown to be highly effective and may be particularly useful in the treatment of recurrent malignant effusions. It would appear that since each of these interventions has their own advantages and risks, the choice of the optimal intervention for MPE would depend on the individual patient’s clinical status and the local expertise and facilities available.

Clinical Topics: Cardiac Surgery, Invasive Cardiovascular Angiography and Intervention, Pericardial Disease, Aortic Surgery

Keywords: Angioplasty, Balloon, Coronary, Cardiac Tamponade, Neoplasm Recurrence, Local, Pericardial Effusion, Pericardiectomy, Pericardiocentesis, Pericardium, Pleural Effusion, Malignant, Sclerosing Solutions, Sclerosis, Sclerotherapy


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