Horr Samuel E, Mentias Amgad, Houghtaling Penny L, Toth Andrew J, Blackstone Eugene H, Johnston Douglas R, Klein Allan L
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Disease, Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Cleveland, Ohio.
Heart and Vascular Institute, Center for the Diagnosis and Treatment of Pericardial Disease, Department of Cardiovascular Medicine and Department of Thoracic and Cardiovascular Surgery Cleveland Clinic, Cleveland, Ohio.
Am J Cardiol. 2017 Sep 1;120(5):883-890. doi: 10.1016/j.amjcard.2017.06.003. Epub 2017 Jun 15.
Comparative outcomes of patients undergoing pericardiocentesis or pericardial window are limited. Development of pericardial effusion after cardiac surgery is common but no data exist to guide best management. Procedural billing codes and Cleveland Clinic surgical registries were used to identify 1,281 patients who underwent either pericardiocentesis or surgical pericardial window between January 2000 and December 2012. The 656 patients undergoing an intervention for a pericardial effusion secondary to cardiac surgery were also compared. Propensity scoring was used to identify well-matched patients in each group. In the overall cohort, in-hospital mortality was similar between the group undergoing pericardiocentesis and surgical drainage (5.3% vs 4.4%, p = 0.49). Similar outcomes were found in the propensity-matched group (4.9% vs 6.1%, p = 0.55). Re-accumulation was more common after pericardiocentesis (24% vs 10%, p <0.0001) and remained in the matched cohorts (23% vs 9%, p <0.0001). The secondary outcome of hemodynamic instability after the procedure was more common in the pericardial window group in both the unmatched (5.2% vs 2.9%, p = 0.036) and matched cohorts (6.1% vs 2.0%, p = 0.022). In the subgroup of patients with a pericardial effusion secondary to cardiac surgery, there was a lower mortality after pericardiocentesis in the unmatched group (1.5% vs 4.6%, p = 0.024); however, after adjustment, this difference in mortality was no longer present (2.6% vs 4.5%, p = 0.36). In conclusion, both pericardiocentesis and surgical pericardial window are safe and effective treatment strategies for the patient with a pericardial effusion. In our study there were no significant differences in mortality in patients undergoing either procedure. Observed differences in outcomes with regard to recurrence rates, hemodynamic instability, and in those with postcardiac surgery effusions may help to guide the clinician in management of the patient requiring therapeutic or diagnostic drainage of a pericardial effusion.
接受心包穿刺术或心包开窗术患者的对比结果有限。心脏手术后心包积液的发生很常见，但尚无数据可指导最佳治疗。利用程序计费代码和克利夫兰诊所手术登记处来识别2000年1月至2012年12月期间接受心包穿刺术或外科心包开窗术的1281例患者。还对656例因心脏手术继发心包积液而接受干预的患者进行了比较。采用倾向评分法在每组中识别匹配良好的患者。在整个队列中，心包穿刺术组和手术引流组的住院死亡率相似（5.3%对4.4%，p = 0.49）。在倾向匹配组中也发现了相似的结果（4.9%对6.1%，p = 0.55）。心包穿刺术后再积聚更为常见（24%对10%，p<0.0001），在匹配队列中也是如此（23%对9%，p<0.0001）。在未匹配队列（5.2%对2.9%，p = 0.036）和匹配队列（6.1%对2.0%，p = 0.022）中，心包开窗术组术后血流动力学不稳定这一次要结局更为常见。在因心脏手术继发心包积液的患者亚组中，未匹配组中心包穿刺术后死亡率较低（1.5%对4.6%，p = 0.024）；然而，调整后，死亡率的这种差异不再存在（2.6%对4.5%，p = 0.36）。总之，心包穿刺术和外科心包开窗术对于心包积液患者都是安全有效的治疗策略。在我们的研究中，接受这两种手术的患者死亡率无显著差异。在复发率、血流动力学不稳定以及心脏手术后积液患者中观察到的结局差异可能有助于指导临床医生对需要心包积液治疗性或诊断性引流的患者进行管理。
