Percutaneous Pericardiocentesis Research Articles

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis

Abstract Background Percutaneous pericardiocentesis (PP) belongs to life-saving procedures in cardiac tamponade, while it may also serve as diagnostic procedure in patients with recurrent pericardial effusion. Purpose The aim of the study was to evaluate the clinical characteristics and predictors of in-hospital mortality among patients subject to PP. Methods This single-center retrospective study comprised consecutive patients who underwent PP between 2011 and 2021 regardless of primary diagnosis. Among 132 456 patients screened, 208 patients were subject to PP [109 women, 52.4%; median age of 66 (58; 76) years] who underwent 231 procedures. Exclusion criteria involved data incompleteness regarding the etiology and outcome. The primary endpoint was in-hospital mortality. Results The most common indications for PP were neoplastic disease (23.1%), idiopathic effusion (14.42%), coronary artery perforation during percutaneous coronary intervention (PCI; 13.9%), viral pericarditis (11.1%), cardiac electronic device implantation (10.6%), catheter ablation (8.7%) and post-pericardiotomy syndrome (5.8%). Overall, iatrogenic cause was the most common indication for PP (41.8%). The median volume of pericardial fluid was 550 (330; 850) ml. In-hospital death was reported in 11 patients (5.3%). Univariate analysis revealed that in-hospital death was predicted by PCI-related etiology (p<0.0001), history of pulmonary embolism (p=0.007) and sudden cardiac arrest (p=0.032), lower pericardial drainage volume (p=0.037), right bundle branch block (p=0.007), cardiogenic shock (p=0.003), packed red blood cells transfusion (p=0.023). Logistic regression indicated that PCI-related etiology (OR 76.1, p<0.001), history of pulmonary embolism (OR 17.9, p=0.03) and recurrent/persistent cardiogenic shock in the course of in-hospital stay (OR 14.7, p=0.004) were independently associated with in-hospital mortality (AUC 0.895; Figure 1). Conclusion Iatrogenic etiology represents the most frequent indication for PP. PCI-related coronary perforation confers the greatest risk of in-hospital death.

Clinical characteristics and risk factors of in-hospital mortality among patients undergoing percutaneous pericardiocentesis.

Percutaneous pericardiocentesis represents a salvage procedure in case of cardiac tamponade and diagnostic procedure in chronic pericardial effusion of unknown source. The study aimed to analyze the clinical characteristics of patients subject to pericardiocentesis and the predictors of in-hospital mortality. The study represents a registry that covered consecutive patients undergoing percutaneous pericardiocentesis from 2011 to 2022 in high-volume tertiary reference center. Electronic health records were queried to obtain demographic and clinical variables. The primary endpoint was in-hospital mortality, while secondary endpoint was the need for recurrent pericardiocentesis. Out of 132 456 patients hospitalized in the prespecified period, 247 patients were subject to percutaneous pericardiocentesis (53.9% women; median age of 66 years) who underwent 273 procedures. In-hospital death was reported in 14 patients (5.67%), while recurrent pericardiocentesis in 24 patients (9.72%). Iatrogenic cause was the most common etiology (42.5%), followed by neoplastic disease (23.1%) and idiopathic effusion (14.57%). In logistic regression analysis in-hospital mortality was associated with myocardial infarction (MI)-related etiology (p = 0.001) and recurrent/persistent cardiogenic shock (p = 0.001). Iatrogenic etiology and neoplastic disease seem to be the most common indications for pericardiocentesis, while in-hospital mortality was particularly high in patients with spontaneous tamponade in the course of MI.

Immediate pericardial protamine administration in acute pericardial tamponade

Abstract Funding Acknowledgements Type of funding sources: None. Aims Cardiac tamponade (CT) is the most common life-threatening complication of interventional electrophysiology. Urgent drainage by percutaneous pericardiocentesis and anticoagulation reversal are required. Immediate direct protamine administration to the pericardial space to the patient has not been described. This study was designed to assess the efficacy and safety of immediate intrapericardial protamine administration (IPPA) in CT as a complication of interventional electrophysiologic procedure. Methods A retrospective case series of IPPA performed for CT was collected. Urgent drainage by percutaneous pericardiocentesis and IPPA were performed to achieve hemodynamic stabilization without emergent surgery. Results Eleven cases of IPPA were included in two tertiary heart centres. Electrophysiological procedures were performed for ventricular tachycardia (n =3), atrial fibrillation (n = 3), left accessory pathway (n = 1), and premature ventricular contraction (n =4) with transseptal (n = 10) and/or retroaortic routes (n =3). Pericardial drainage was performed by percutaneous pericardiocentesis for all 11 patients. Surgical haemostasis was not required for our cohort. The mean volume of drained pericardial fluid was 486ml (200-1200) Mean IPPA dosage was 209mg (100-800). Mean systemic protamine dosage was 86mg(50-100). No complication was observed on the follow-up. Conclusion IPPA is a feasible, safe, and useful technique for salvage therapy in CT. Conclusion IPPA is a feasible, safe, and useful technique for salvage therapy in ACT in interventional electrophysiology.

1004 AN UNUSUAL, UNAVOIDABLE BUT SUCCESSFUL MANAGEMENT OF TYPE A AORTIC DISSECTION. A CASE REPORT

Abstract Background Cardiac tamponade complicates 18,7% of patients with type A aortic dissection and is associated with dramatically worse outcome and a nearly doubling of in-hospital mortality. Immediate surgical repair with intra-operative pericardial drainage is the treatment of choice. Nevertheless, the management of unstable patients who cannot undergo cardiac surgery in short time is controversial. Case report Here we present a case report of an 82-year woman with type A aortic dissection complicated by cardiac tamponade. The patient alerted the emergency system because of a sudden epigastric pain. On her arrival to the hospital, her systolic blood pressure was 50 mmHg; despite intravenous fluids and inotropic support, she remained hypotensive. Transthoracic echocardiography revealed an intimal flap involving ascending aorta and aortic arch, and a hemodynamically significant pericardial effusion. Immediate surgical repair was not possible due to the lack of available operating rooms. To stabilize the patient, percutaneous pericardiocentesis from apical approach was attempted, unsuccessfully. A second attempt of percutaneous pericardiocentesis was made from substernal approach, with removal of just 150 cc of pericardial fluid and insertion of a pigtail drainage catheter. Thanks to this procedure systolic blood pressure raised up to 100 mmHg and the patient was stabilized. A CT Angiography scan was performed, showing an aortic dissection extending from the aortic valvular plane to the origin of the right iliac artery. The patient maintained hemodynamical stability until surgical intervention, which started four hours later her arrival. The patient underwent substitution of ascending aorta, aortic hemiarch, non-coronary sinus and aortic valve. There were no complications related to the pericardial drainage and in 34th post-operative day she was discharged in good condition. Conclusion Percutaneous pericardiocentesis should be considered in unstable patients with type A dissection complicated by cardiac tamponade who cannot await surgical treatment, providing that very small amount of pericardial fluid is removed, in order to maintain systolic blood pressure around 90 mmHg.

Outcomes of malignant pericardial effusion associated with solid cancers based on treatment modality.

e18712 Background: Malignant pericardial effusions (MPE)/Cardiac Tamponade (CT) are often severe manifestations of malignancy, and patients with significant effusions have reduced survival. The most commonly associated solid cancers with MPE are cancers of the lung (L), Breast (B), Esophagus (E), Stomach (S), and Melanoma (M). The data on in-hospital outcomes of MPE based on the treatment modality is relatively limited. Methods: We performed a retrospective study using the National Inpatient Sample (NIS) database from 2016-2019 and identified all admissions with a concomitant discharge diagnosis of MPE/CT and solid cancer (L/B/E/S/M) using ICD 10 codes. These patients were divided into 3 subgroups based on the method of treatment: percutaneous pericardiocentesis only (PP), surgical pericardiotomy only (SP), or both (PP+SP). The three subgroups were compared for outcomes of inpatient mortality, Length of stay (LOS), and total hospitalization charges (THCG). Statistical analysis was done using t-test, chi-square test, and multivariate logistic analysis. Results: 63,939 patients met inclusion criteria (combining the five cancers as above). Of those, 8925, 6119, and 929 patients underwent PP, SP, and both, respectively. The mean age of patients in all three groups was 62 years. Majority of the patients in the three groups were of white ethnicity (69.8%, 72.03%, 60.89 %) and were admitted in large-sized (60%) urban teaching hospitals (82%) and had Medicare (45%). The PP and SP group had more females (54%,56%), and the PP+SP group had a higher proportion of males (53%). 13%,9%, and 14% of the PP, SP, and PP+ SP group patients died during the hospitalization. In comparison to PP group, patients in SP group had a significant decrease in mortality (aOR 0.77, 95% CI 0.61-0.97, p = 0.02*) and the mortality did not change in PP+SP group (aOR 1.10, 95% CI 0.69-1.74, p = 0.6).The mean LOS was 8 days, 9 days, and 12 days in PP, SP, and PP+ SP groups (p < 0.0001*), and the THCG per admission was higher by $28,457 in the SP group and $60,282 in the PP+SP group (p < 0.0001*). Furthermore, Black patients with MPE (aOR = 1.463,95% CI = 1.09-1.95, p = 0.01*) and Failure to thrive comorbidity (aOR = 2.47,95% CI = 1.37-4.4, p = 0.003*) had an increase in mortality regardless of the procedure type. Conclusions: Patients with MPE who underwent surgical pericardiotomy had lower mortality than those who underwent percutaneous pericardiocentesis. In addition, surgical and combined interventions resulted in higher healthcare resource utilization (LOS and THCG). This study highlights the treatment-based mortality difference and notes important trends in demographics. These findings suggest a mindful decision on the type of treatment intervention for MPE. Further studies are needed to evaluate the reasons for racial differences in MPE outcomes and ways to mitigate them. *p value = < 0.05 was considered statistically significant ;aOR = Adjusted Odds Ratio.

Outcomes of Patients with and without Malignancy Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion.

(1) Background: This study aimed to evaluate the etiologies and clinical outcomes of patients with pericardial effusion (PE) treated with echo-guided percutaneous pericardiocentesis. (2) Methods: Between July 2010 and December 2020, a total of 502 patients underwent echo-guided percutaneous pericardiocentesis for PE at our hospital. The reasons for PE were malignancy (N = 277), and non-malignancy (N = 225). The comorbidities, complications, and all-cause mortality were compared between the malignancy and non-malignancy groups. (3) Results: In multivariable Cox regression analyses for 1-year mortality, malignancy related PE, nasopharyngeal and oropharyngeal cancer, and metastatic status were positive predictors. A higher incidence of in-hospital and 1-year mortality were observed in patients with malignancy-related PE than with non-malignancy-related PE. In patients with malignancy-related PE, the Kaplan-Meier curve of 1-year all-cause mortality significantly differed between patients with or without metastasis; however, PE with or without malignant cells did not influence the prognosis. (4) Conclusions: In the patients with large PE requiring percutaneous pericardiocentesis, malignancy-related PE, nasopharyngeal and oropharyngeal cancer, and metastatic status were positive predictors of 1-year mortality. In patients with malignancy, a higher incidence of all-cause mortality was noted in patients with metastasis but did not differ between the groups with and without malignant cells in PE.

Clinical features and factors affecting in-hospital mortality of patients who underwent pericardiocentesis due to moderate to severe pericardial effusion

Objectives: The aim of this study was to determine the primary etiology of pericardial effusion in patients undergoing percutaneous pericardiocentesis. Possible in-hospital mortality related predictors were also investigated. Patients and Methods: A retrospective analysis was made of the clinical and laboratory features of 268 patients who underwent pericardiocentesis due to moderate to severe pericardial effusion between January 2009 and March 2020. Results: The patients comprised 57.5% males and 42.5% females with a mean age of 62.3±15.4 years. Cardiac compression was detected in 220 (82.1%) patients, of which 208 (77.6%) were clinically tamponade and 12 (4.5%) were asymptomatic cardiac compression. The most common symptom was dyspnea (58.6%) and 10.8% of patients were asymptomatic. Pericardial fluid was exudate in 235 (87.7%) patients. The most common causes were malignancy (37.3%) followed by idiopathic (22.1%) and iatrogenic (12.7%) causes. The patients with asymptomatic cardiac compression were more likely to have malignant effusion than those with other etiologies (p=0.001). In-hospital mortality developed in 37 (13.8%) patients. The independent predictors of in-hospital mortality were determined as follows; etiology other than infectious or idiopathic (OR = 3.447; 95% CI = 1.266, 9.386; p = 0.015), and receiving antithrombotic therapy (OR = 2.306; 95% CI = 1.078, 4.932; p=0.031). Conclusion: Malignancy is the most common cause of moderate to severe pericardial effusions. The detection of cardiac compression in asymptomatic patients may be an important indicator of malignancy. Receiving antithrombotic therapy and having a non-idiopathic and non-infectious etiology may be predictors of in-hospital mortality.

Comparison of PLANE Technique versus Standard Echocardiography Guidance for Pediatric Pericardiocentesis

AbstractPercutaneous pericardiocentesis remains a challenging and potentially dangerous procedure, particularly in small, critically ill patients. We present outcomes of the PLANE (pericardiocentesis using long-axis in-plane real-time echocardiography) technique for pediatric pericardiocentesis compared with a standard echocardiography (ECHO) guidance cohort. This was a retrospective chart review of all children undergoing percutaneous pericardiocentesis from March 2013 to February 2021 at a single center. A total of 78 procedures were performed, 52 utilizing PLANE technique and 26 utilizing standard ECHO-guidance technique. There was 100% technical success rate with only one minor complication for the entire cohort. Procedures were evenly split between the bedside intensive care unit and cardiac catheterization laboratory. PLANE technique was utilized in significantly younger (1.4 vs. 8.4 years, p = 0.008) and smaller (11.1 vs. 31.8 kg, p = 0.007) patients, as well as in most patients deemed high risk (postoperative < 7 days, extracorporeal membrane oxygenation (ECMO) support, and/or weight less than 5 kg; 19/22, p = 0.021). Other patient characteristics were similar between the two groups. There was a trend toward PLANE technique utilization by noncardiology trained operators. The PLANE technique for pediatric pericardiocentesis is safe and effective and can be effectively utilized in small and high-risk patient populations. The technical similarity to other long-axis ultrasound-guided procedures may facilitate adoption and mastery by critical care trained operators.

VP21.09: Postnatal oral sirolimus therapy in fetal cardiac rhabdomyoma

Treatment options include off-label use of Sirolimus, pericardiocentesis, open fetal resection or postnatal surgery. After delivery at 36 weeks, titrated oral Sirolimus therapy was started from day 2 in view of LV inflow obstruction. Serial echocardiography revealed increase in size, appearance of smaller masses and large pericardial effusion (PE) for which percutaneous pericardiocentesis was done at 26 weeks. [Extracted from the article] Copyright of Ultrasound in Obstetrics & Gynecology is the property of John Wiley & Sons, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Demographic, clinical and etiological profile of pericardial effusion in India: A single centre experience

IntroductionPericardial effusion (PE) is a life-threatening condition. However, there are very few Indian studies which determined etiological distribution. The current retrospective observational study was carried out to assess etiological factors responsible for PE in a tertiary care centre in India. MethodsThe study enrolled consecutive 55 patients with the diagnosis of moderate to large PE as established by echocardiography between January 2018 and December 2018. The echocardiography guided percutaneous pericardiocentesis was performed by the standard procedure. ResultsAmongst the enrolled PE patients in the study, 30 (54.55%) were males and 25 (45.45%) were females, with the average age of 43.00 ± 15.54 years. In clinical assessment, tamponade was found in 52 (94.54%) patients. Tuberculosis was the most common etiology for PE (n=35, 63.64%) followed by hypothyroidism (n = 6, 10.9%), and malignancies (n = 4, 7.27%). Among 12.72% patients, the PE was of recurrent type. Additionally, no death or any complication was encountered during pericardiocentesis. ConclusionPericardial disease and effusion is a major cause of morbidity in India. Despite developments in the healthcare facilities, tuberculosis was the most common etiology for PE. Additionally, the raised number of hypothyroid and malignant PE cases demonstrates the changing etiological trends, similar to western countries.

High frequency ultrasound-guided pericardiocentesis performed in the sitting position: A novel apical approach.

BackgroundSo far, few approaches have been described to reduce inadvertent injury to structure of the heart and nearby organs in percutaneous pericardiocentesis.HypothesisWe hypothesized that an in‐plane high frequency ultrasound‐guided apical approach, performed in the sitting position, would provide additional benefits in terms of feasibility and safety for draining malignant pericardial effusion (MPE).MethodsThe authors selected 53 consecutive patients with moderate or large symptomatic MPE who underwent high frequency ultrasound‐guided pericardiocentesis. After the procedure, all patients were followed for 90 days with the main purpose of detecting procedure success, procedure‐related complications, and recurrent PE.ResultsProcedure success rate for pericardiocentesis was 100%. All patients were placed in the sitting position with their left hands extended above the heads. An apical puncture approach was performed in all cases (100%). The mean duration of catheter drainage was 8.1 ± 3.2 days. The mean initial amount of pericardial fluid drained was 956.3 ± 687.5 ml. Overall, six patients (11%) had recurrent PE; 3 (6%) had repeated percutaneous pericardiocentesis. There was no major complication and minor complications occurred in four patients (8%).ConclusionThis novel in‐plane high frequency US‐guided apical approach has several advantages for percutaneous pericardiocentesis of MPE: performed in the sitting position; a benefit for patients with orthopnea; a maximum inserted wide angle to prevent damage to the myocardium; local enlargement of the PE region; high procedure success rate of pericardiocentesis; and excellent clinical outcomes.

Prognostic Factors and Overall Survival After Pericardiocentesis in Patients With Cancer and Thrombocytopenia.

Background: Pericardiocentesis is an important diagnostic and therapeutic tool for cancer-associated pericardial effusion. Limited safety and outcomes data exists regarding the management of malignancy-related pericardial effusion in patients with thrombocytopenia.Objectives: Our study aimed to analyze prognostic factors and overall survival (OS) after pericardiocentesis in thrombocytopenic cancer patients.Methods and Results: A retrospective review of 136 thrombocytopenic cancer patients who underwent primary percutaneous pericardiocentesis was performed. Degree of thrombocytopenia was classified by platelet count recorded on day of pericardiocentesis: 75–149 × 103 cells/μL (41%); 50–74 × 103 cells/μL (10%); 25–49 × 103 cells/μL (24%); <25 × 103 cells/μL (25%). Median OS was 2.6 months and median follow-up was 37.4 months. Kaplan-Meier survival analysis showed significant OS differences among thrombocytopenia severity groups (p = 0.023), and worse OS with platelets <100 vs. ≥100 × 103 cells/μL (p = 0.031). By univariate analysis, thrombocytopenia severity was associated with increased risk of death (HR 0.993; 95% CI 0.989–0.997; p = 0.002). Poor prognostic factors for OS were advanced cancer, malignant effusion, elevated international normalized ratio (INR), quantity of platelet transfusions, and platelet transfusion resistance. However, thrombocytopenia severity became insignificant for OS (p = 0.802), after adjusting for advanced cancer and INR.Conclusions: For patients with malignancy-related large pericardial effusion and thrombocytopenia, pericardiocentesis is a feasible intervention and should be considered due to low complication rates. There is no absolute contraindication to pericardiocentesis in case of hemodynamic instability, even with severe thrombocytopenia.

Cardiac Tamponade - A Hypothyroidism Associated Emergency: A Report of 2 Cases

Pericardial effusion in commonly seen in-patient with hypothyroidism but effusion large enough to cause cardiac tamponade is not a common presenting feature whereas myxedema coma is a commonly defined medical emergency in-patient with hypothyroidism. We report 2 cases of hypothyroid associated medical emergencies. First case is a young female with history of recurrent pericardial effusion presenting to the emergency department with cardiac tamponade and later on diagnosed as having hypothyroidism. The second patient is a known case of hypothyroidism non-compliant to thyroid supplement and presented with lethargy, fatigue, decreased talking and breathlessness who was later diagnosed as having myxedema coma and impending cardiac tamponade. Both the patient required percutaneous pericardiocentesis and improved with medical management.

Percutaneous pericardiocentesis for pericardial effusion: predictors of mortality and outcomes.

Pericardial effusion can dangerously precipitate patient’s hemodynamic stability and requires prompt intervention in case of tamponade. We investigated potential predictors of in-hospital mortality, a composite outcome of in-hospital mortality, pericardiocentesis-related complications, and the need for emergency cardiac surgery and all-cause mortality in patients undergoing percutaneous pericardiocentesis. This is an observational, retrospective, single-center study on patients undergoing percutaneous pericardiocentesis (2010–2019). We enrolled 81 consecutive patients. Median age was 71.4 years (interquartile range [IQR] 58.1–78.1 years) and 51 (63%) were male. Most of the pericardiocentesis were performed in an urgency setting (76.5%) for cardiac tamponade (77.8%). The most common etiology was idiopathic (33.3%) followed by neoplastic (22.2%). In-hospital mortality was 14.8% while mortality during follow-up (mean 17.1 months) was 44.4%. Only hemodynamic instability (i.e., cardiogenic shock, hypotension refractory to fluid challenge therapy and inotropes) was associated with in-hospital mortality at the univariate analysis (odds ratio [OR] 7.2; 95% confidence interval [CI] 1.76–29.4). Non-neoplastic/non-idiopathic etiology and hemodynamic instability were associated with the composite outcome of in-hospital mortality, need for emergency cardiac surgery, or pericardiocentesis-related complications (OR 5.75, 95% CI 1.65–20.01, and OR 5.81, 95% CI 2.11–15.97, respectively). Multivariate Cox regression analysis adjusted for possible confounding variables (age, coronary artery disease, and hemodynamic instability) showed that neoplastic etiology was independently associated with medium-term mortality (hazard ratio [HR] 4.05, 95% CI 1.45–11.36). In a real-world population treated with pericardiocentesis for pericardial effusion, in-hospital adverse outcomes and medium-term mortality are consistent, in particular for patients presenting with hemodynamic instability or neoplastic pericardial effusion.

Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis.

Pericardiocentesis is traditionally performed using a subxiphoid approach. Hepatomegaly or loculated and noncircumferential effusions warrant nonstandard approaches to drain effusions; echocardiographic guidance has made these less traditional, non-subxiphoid approaches feasible. The study is aimed at comparing clinical outcomes of the subxiphoid and non-subxiphoid approaches to percutaneous pericardiocentesis in a pediatric population. This is a retrospective chart review of all children undergoing percutaneous pericardiocentesis from August 2008 to December 2019 at a single-center. A total of 104 patients underwent echocardiography-guided pericardiocentesis during the timeframe. Additionally, fluoroscopy was also used in 80 patients. Hematopoietic stem cell transplantation was the most common underlying diagnosis (n = 53, 50.9%). A non-subxiphoid approach was used in 58.6% (n = 61) of patients. The fifth and sixth intercostal spaces were the most commonly used (n = 17 each). The non-subxiphoid group tended to be older (95.9 vs. 21.7months, p = 0.006) and weighed more (23.6 vs. 11.2kgs, p = 0.013) as compared to the subxiphoid group. Non-subxiphoid approach was associated with shorter procedure times (21 vs. 37min, p = 0.005). No major complications were seen. Five minor complications occurred and were equally distributed in the two groups. Complications were more likely in younger patients (p = 0.047). The technique and anatomic approach to pericardiocentesis, and the location or size of effusion did not influence the risk of complications. Echocardiography-guided percutaneous pericardiocentesis in children was associated with low complication rates in this single-center pediatric experience. The use of a non-traditional, non-subxiphoid approach was associated with shorter procedure times and did not significantly affect complication rates.

Percutaneous drainage of large pericardial effusion in intensive care unit: Safety and outcome

Large pericardial effusion (LPE) management can be challenging in intensive care unit. Data regarding the prognosis of LPE undergoing percutaneous pericardiocentesis are scarce. To assess the safety of percutaneous pericardiocentesis. To evaluate the outcome of LPE managed with percutaneous pericardiocentesis. Patients who underwent percutaneous drainage of an LPE from November 2011 to October 2019 in the intensive care unit of a tertiary care center were included. Procedure-related complications, overall survival and effusion recurrence rate and were analyzed. One hundred and seventy nine percutaneous pericardiocentesis were performed in One hundred and seventy one patients. Procedure was successful in 97.8% of the cases. A subxiphoid approach was used in 81.6%, an apical approach in 17.3% and a right parasternal approach in 1.1% of the cases. There were 5 complications (2.8%) that all occurred with a subxiphoid approach. There were no procedure-related deaths. No predictive factors for success or complication of the procedure were found. Most common etiologies were neoplasia (43.3%) and iatrogenicity (14.0%). Most frequent malignancies were lung cancer (54.1%), lymphoma (9.5%) and leukemia (6.8%). Cancer was previously unknown for 14.9% of patients with malignancy-related effusions. Presence of malignant cells in the pericardial fluid was an independent factor of 30-days and 1-year mortality ( P = 0.007 and P = 0.005, respectively) in the multivariate analysis (adjustment on active neoplasia, lung cancer and LPE recurrence). A total of 10.5% of patients had LPE recurrence. 94.4% of recurrences occurred in the first 100 days. No predictive factors for recurrence were found ( Fig. 1 ). Percutaneous pericardiocentesis is efficient for treating patients with LPE. Apical approach is safe in our experience. Presence of malignant cells in pericardial fluid analysis is strongly associated with mortality. Follow-up should be more frequent during the first 3 months after drainage.

Pericardial Effusion Treated With Percutaneous Pericardiocentesis; Aetiology and Outcomes From a Major Oncological Centre

Pericardial effusion is a rare complication of cancer; pericardiocentesis serves as both a diagnostic and therapeutic approach to patients with this presentation. We reviewed the aetiologies and outcomes of patients treated with pericardiocentesis in a major oncology centre.

Management of acute cardiac tamponade by direct autologous blood transfusion in interventional electrophysiology

Acute cardiac tamponade (ACT) is the most common life-threatening complication of interventional electrophysiology. Urgent drainage by percutaneous pericardiocentesis and anticoagulation reversal are required. Immediate direct transfusion of the blood volume aspirated from the pericardial space to the patient has been rarely described. This study was designed to assess the efficacy and safety of immediate direct autologous blood transfusion (AutoBT). A retrospective case series of direct AutoBT performed for ACT was collected. Urgent drainage by percutaneous pericardiocentesis and immediate direct AutoBT into the femoral sheath of the blood volume aspirated from the pericardial space, were performed to achieve hemodynamic stabilization. Twenty-two electrophysiology centers were contacted to participate to the case series. Fourteen centers reported not to use direct AutoBT. Fourteen cases of immediate direct AutoBT were included from the five remaining centers. Electrophysiological procedures were performed for ventricular tachycardia ( n = 5), atrial fibrillation ( n = 5), atrial tachycardia ( n = 2), left accessory pathway ( n = 1) and premature ventricular contraction ( n = 1) with transseptal ( n = 9), retroaortic ( n = 4) and/or epicardial access ( n = 4). Pericardial drainage was performed by percutaneous pericardiocentesis for 13 patients and via the transseptal sheath for one patient. Surgical hemostasis was required for 7 patients. The mean volume of autologous blood directly transfused was 1207 ± 963 ml Direct AutoBT permitted to resume the procedure in 4 patients. 13 patients (93%) were discharged with a hospital stay of 12.3 ± 17.1 days. No major complication related to the use of AutoBT occurred ( table 1 ). Direct AutoBT without cell-saver system is a feasible and useful technique for salvage therapy in acute cardiac tamponade in interventional electrophysiology.

Purulent pericardial effusion in children: Experience from a tertiary care center in North India.

Background:Purulent pericarditis, if not recognized and managed timely, it can lead to significant morbidity and mortality. There are no guidelines for the management of purulent pericardial effusion in pediatric patients.Aim:The study describes our experience with the management of 22 patients admitted with a primary diagnosis of purulent pericardial effusion seen over a 7-year period.Materials and Methods:Hospital records of 22 children admitted to the pediatric intensive care unit with purulent pericardial effusion during January 2012–December 2018 were retrospectively analyzed.Results:The mean age of presentation was 4.6 years. The most common presentation was fever. History of antecedent trauma was present in 27.27% of patients. Empyema was the most common associated infection. Staphylococcus aureus was the most commonly isolated organism. Out of 22, pericardial drainage was done in 13 patients (59%). Only one of these patients required pericardiectomy later on. Six (27.2%) patients responded to antibiotics alone. Three (13.6%) patients died before any intervention could be planned.Conclusion:Echocardiography-guided percutaneous pericardiocentesis and pigtail catheter placement are a safe and effective treatment for purulent pericardial effusion. When pericardial drainage is not amenable, close monitoring of the size of effusion by serial echocardiography is required. Small residual pericardial effusion may be managed conservatively.

224 Malignancy associated pericardial effusion- do we need to drain them all?

Abstract On Behalf Cardiac Team, Department of Medicine, Queen Elizabeth Hospital Background Management of significant pericardial effusion in cancer patients is controversial. These patients have poor prognosis, and avoiding unnecessary intervention is important. Close monitoring of symptoms and echocardiogram is often a reasonable option, but inherits risk of cardiac tamponade. Whether pericardial drainage by means of percutaneous pericardiocentesis or surgical pericardiotomy could prevent future deterioration or affect survival is unknown. Purpose To evaluate the benefit of elective pericardial drainage in malignancy associated pericardial effusion without echocardiographic or clinical evidence of tamponade effect. Methods From 1st Jul 2014 to 31st Dec 2017, all patients with new onset malignancy-associated pericardial effusion with size more than 1cm were retrospectively analyzed. Patients with clinical or echocardiographic evidence of cardiac tamponade were excluded. We compared pericardial drainage versus monitoring for short-term (30-day), mid-term (90-day) and long term (1 year) survival without need for drainage. Results 101 patients were retrospectively analyzed. 40 (39.6%) patients underwent drainage. Overall median survival free from drainage was 4 months. There were no significant difference in short-term (30-day), mid-term (90-day) and long term (1-year) survival free from drainage or mortality between treatment and monitoring group. Size of pericardial effusion did not predict mortality or future need of drainage. Chemotherapy was associated with improved 30-day mortality (RR 0.53 CI 0.32-0.87 p = 0.025) but not survival free from drainage or longer term mortality. Conclusion Close monitoring could be a feasible strategy in cancer patients with significant pericardial effusion without tamponade effect. Baseline characteristics Factor Drainage (n = 40) monitoring (n = 61) p-value method of drainage pericardiocentesis alone 17 NA pericardiotomy alone 13 both 10 Male 19 (47.5%) 27 (44.3%) 0.749 mean size (cm) 1.93 2.77 &amp;lt;0.001 mean age 60.9 63.1 0.357 on chemotherapy 27 (67.5%) 38 (62.3%) 0.593 Abstract 224 Figure. Survival free from drainage