Surgical Management Strategies for Pericardial Effusion—A Systematic Review
Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous...
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| Published in | Journal of clinical medicine Vol. 14; no. 14; p. 4985 |
|---|---|
| Main Authors | , , , , , , , , , , |
| Format | Journal Article |
| Language | English |
| Published |
Switzerland
MDPI AG
14.07.2025
MDPI |
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| Online Access | Get full text |
| ISSN | 2077-0383 2077-0383 |
| DOI | 10.3390/jcm14144985 |
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| Abstract | Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review. Methods: A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted. Results: A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47–62.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%). Conclusions: Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology. |
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| AbstractList | Objectives
: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review.
Methods
: A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted.
Results
: A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47–62.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%).
Conclusions
: Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology. : Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review. : A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted. : A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47-62.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%). : Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology. Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review. Methods: A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted. Results: A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47–62.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%). Conclusions: Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology. Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review. Methods: A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted. Results: A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47-62.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%). Conclusions: Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology.Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review. Methods: A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted. Results: A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47-62.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%). Conclusions: Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology. |
| Audience | Academic |
| Author | Naseer, Javeria Hameed, Irbaz Cangut, Busra Mubasher, Ayesha Shafqat, Shanzil Qasba, Ruman K. Fatima, Maurish Talapaneni, Sriharsha Avilala, Shreya Nasir, Afsheen Alhazmi, Amnah |
| AuthorAffiliation | 1 Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA; rumankhurshid@gmail.com (R.K.Q.); amnahralhazmi@gmail.com (A.A.); jnmardan@gmail.com (J.N.); st1222@georgetown.edu (S.T.); maurishfatima16@gmail.com (M.F.); afsheen.nasir@yale.edu (A.N.); anzil.shafqat21@dimc.duhs.edu.pk (S.S.); avila082@umn.edu (S.A.) 2 Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; busra.cangut@mountsinai.org |
| AuthorAffiliation_xml | – name: 1 Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA; rumankhurshid@gmail.com (R.K.Q.); amnahralhazmi@gmail.com (A.A.); jnmardan@gmail.com (J.N.); st1222@georgetown.edu (S.T.); maurishfatima16@gmail.com (M.F.); afsheen.nasir@yale.edu (A.N.); anzil.shafqat21@dimc.duhs.edu.pk (S.S.); avila082@umn.edu (S.A.) – name: 2 Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA; busra.cangut@mountsinai.org |
| Author_xml | – sequence: 1 givenname: Ruman K. orcidid: 0009-0001-6637-596X surname: Qasba fullname: Qasba, Ruman K. – sequence: 2 givenname: Busra surname: Cangut fullname: Cangut, Busra – sequence: 3 givenname: Amnah surname: Alhazmi fullname: Alhazmi, Amnah – sequence: 4 givenname: Javeria surname: Naseer fullname: Naseer, Javeria – sequence: 5 givenname: Ayesha surname: Mubasher fullname: Mubasher, Ayesha – sequence: 6 givenname: Sriharsha surname: Talapaneni fullname: Talapaneni, Sriharsha – sequence: 7 givenname: Maurish surname: Fatima fullname: Fatima, Maurish – sequence: 8 givenname: Afsheen surname: Nasir fullname: Nasir, Afsheen – sequence: 9 givenname: Shanzil surname: Shafqat fullname: Shafqat, Shanzil – sequence: 10 givenname: Shreya surname: Avilala fullname: Avilala, Shreya – sequence: 11 givenname: Irbaz orcidid: 0000-0003-4954-4685 surname: Hameed fullname: Hameed, Irbaz |
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| Keywords | pericardial effusion subxiphoid pericardial window video assisted thoracoscopic surgery (VATS) |
| Language | English |
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| Snippet | Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used... : Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for... Objectives : Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used... Objectives : Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used... |
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| SubjectTerms | Cardiac arrhythmia Care and treatment Causes of Chest tubes Disease Etiology Evidence Heart Infections Length of stay Mortality Ostomy Patients Pediatrics Pericardial effusion Pericardium Pneumonia Pneumothorax Prognosis Surgery Systematic Review Tuberculosis |
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| Title | Surgical Management Strategies for Pericardial Effusion—A Systematic Review |
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