From the Guidelines
Pericardiotomy is indicated when pericardiocentesis cannot be performed, particularly in cases of malignant pericardial effusion or cardiac tamponade requiring drainage. The indications for pericardiotomy can be summarized as follows:
- Malignant pericardial effusion with cardiac tamponade or recurrent effusions that have failed conservative management 1
- Pericardial effusion that cannot be drained by pericardiocentesis, such as in cases of loculated effusions or presence of adhesions 1
- Pericardial masses or tumors requiring biopsy or removal, including primary or secondary malignant tumors 1
- Constrictive pericarditis causing hemodynamic compromise, although pericardiectomy is rarely indicated for this condition 1
- As part of cardiac surgeries, such as coronary artery bypass grafting or valve replacement, where direct access to the pericardial space is required The procedure can be performed under local anesthesia, but it carries risks of complications, including myocardial laceration, pneumothorax, and mortality 1. Surgical pericardiotomy does not improve clinical outcomes over pericardiocentesis and is associated with a higher rate of complications. Percutaneous balloon pericardiotomy and pericardial window creation via left minithoracotomy are alternative approaches that may be effective and safe in selected cases 1.
From the Research
Indications for Pericardiotomy
The indications for pericardiotomy are varied and depend on the underlying cause of the pericardial effusion or cardiac tamponade. Some of the key indications include:
- Cardiac tamponade, which is a life-threatening condition that requires immediate treatment 2, 3, 4
- Recurrent pericardial effusion, which can be treated with percutaneous balloon pericardiotomy or surgical pericardiotomy 5, 6
- Malignant pericardial effusion, which can be treated with pericardiotomy and pericardial sclerosis 6
- Traumatic cardiac tamponade, which may require surgical pericardiotomy 3
- Effusive-constrictive pericarditis, which may require surgical pericardiotomy 4
- Loculated pericardial effusions, which may require surgical pericardiotomy 4
Specific Patient Populations
Certain patient populations may benefit from pericardiotomy, including:
- Patients with cancer, who may develop malignant pericardial effusion 2, 5, 6
- Patients with a history of cardiac surgery, who may develop post-operative pericardial effusion 4
- Patients with chest trauma, who may develop traumatic cardiac tamponade 3
Diagnostic Considerations
Pericardiotomy may be indicated in patients with cardiac tamponade or recurrent pericardial effusion, and may be performed after diagnostic evaluation with echocardiography or other imaging modalities 2, 3, 4.