CT-Guided Drainage of Pericardial Effusion after Open Cardiac Surgery.

Abstract

This study was designed to evaluate the safety and efficacy of CT-guided drainage of the pericardial effusion in patients after cardiac surgery. The study included 128 consecutive patients (82 males, 46 females; mean age 66.6years, SD: 4.2) complicated by pericardial effusion or hemopericardium after cardiac surgeries between June 2008 and June 2016. The medical indication for therapeutic pericardiocentesis in all patients was hemodynamic instability caused by pericardial effusion. The treatment criteria for intervention were evidence of pericardial tamponade with ejection fraction (EF)<50%. The preintervention ejection fraction was determined echocardiographically with value between 30 and 40%. Exclusion criteria for drainage were hemodynamically unstable patients or impaired coagulation profile (INR<1.8 or platelet count<75,000). Drains (8F-10F) were applied using Seldinger's technique under CT guidance. Pericardiocentesis and placement of a percutaneous pericardial drain was technically successful in all patients. The mean volume of evacuated pericardial effusion was 260ml (range 80-900ml; standard deviation [SD]: ±70). Directly after pericardiocentesis, there was a significant improvement of the ejection fraction to 40-55% (mean: 45%; SD: ±5; p<0.05). The mean percentage increase of the EF following pericardial effusion drainage was 10%. The drainage was applied anteriorly (preventricular) in 39 of 128 (30.5%), retroventricularly in 33 of 128 (25.8%), and infracardiac in 56 of 128 (43.8%). Recurrence rate of pericardial effusion after removal of drains was 4.7% (67/128). Complete drainage was achieved in retroventricular and infracardiac positioning of the catheter (p<0.05) in comparison to the preventricular position of the catheter. Recorded complications included minimal asymptomatic pneumothorax and pneumomediastinum 2.3% (3/128) and sinus tachycardia 3.9% (5/128). CT-guided drainage of postoperative pericardial effusion is a minimally invasive technique for the release of the tamponade effect of the effusion and improvement of cardiac output.