Retrospective comparison of percutaneous balloon pericardiotomy with pericardiocentesis versus pericardiocentesis alone for management of symptomatic pericardial effusions

Abstract

Background Cardiac tamponade is a potentially life-threatening complication of pericardial effusion. Pericardiocentesis with drainage is the mainstay of treatment for patients with pericardial effusion and cardiac tamponade. Percutaneous balloon pericardiotomy (PBP) is an adjunct to pericardiocentesis that may alleviate the risk for recurrent effusion and repeat procedures. However, the efficacy of PBP plus pericardiocentesis compared to pericardiocentesis alone is not clear. Purpose We sought to determine whether PBP plus pericardiocentesis was associated with less recurrence of pericardial effusion than pericardiocentesis alone. Methods We conducted a single-centre retrospective analysis of patients ≥18 years old with non-iatrogenic pericardial effusion undergoing either pericardiocentesis alone or PBP plus pericardiocentesis for the first time. For PBP, a balloon was advanced over a guidewire until it crossed the pericardium and was then inflated until the balloon profile was fully expanded. Type of balloon used, and single or double balloon technique were left up to the operator. Recurrent pericardial effusion was defined as a large pericardial effusion on echocardiogram, pericardial effusion that caused hemodynamic compromise, or pericardial effusion that necessitated another intervention to drain at any time after initial procedure. Risk factors for recurrent pericardial effusion were also assessed. Results There were 208 patients who underwent pericardiocentesis, with 33 patients receiving PBP plus pericardiocentesis. In all patients, the rate of recurrent pericardial effusion was 15.9% and 15.2%, respectively (p=0.92). In patients with a cancer diagnosis at time of procedure, the rate of recurrent pericardial effusion was 17.8% and 16.7%, respectively (p=0.89). In patients with malignant pericardial effusion as confirmed by cytology, the rate of recurrent pericardial effusion was 20.4% and 13.3%, respectively (p=0.72). Patients with a connective tissue disease (CTD) had an increased odds ratio (OR) of recurrent pericardial effusion when compared to patients without a CTD (OR 3.19, 95% CI 1.31–7.77). Conclusions The results of this study suggest that PBP plus pericardiocentesis offers no significant benefit over pericardiocentesis alone at preventing recurrent pericardial effusion. This finding was true in all sub-groups, including patients with cancer and patients with malignant pericardial effusion. Patients with a CTD were three times more likely than patients without a CTD of having a recurrent pericardial effusion, independent of treatment strategy. Funding Acknowledgement Type of funding sources: None.