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Ann Thorac Surg 2005;79:387
© 2005 The Society of Thoracic Surgeons
St. Joseph Mercy Hospital, 5301 E Huron River Dr, Ann Arbor, MI 48106, USA
lampmanr{at}trinity-health.org
To the Editor:
We appreciate the comments of Dr Allen. Allen and colleagues reported a similar complication rate (9%; 2 of 23 patients) when performing echo-guided pericardiocentesis in a small series such as ours (10%; 3 of 29 patients), yet only endorse this technique for patients with hemodynamic instability who could not tolerate a subxiphoid pericardiostomy [1, 2]. They point out that only half of the procedures could be done under local anesthetia with sedation. Our technique allowed for 96% of our patients to forgo a general anesthetic. The significance of this should not be overlooked, given that these patients have multiple comorbidities and may be in the terminal stages of their disease. In addition, although we did not formally address this in the article, it is our experience that pericardiocentesis with extended catheter drainage is much less painful for patients; they required fewer narcotics and had shorter recovery times. This allows many patients with very limited life expectancies the opportunity to return to their normal activities and potentially be discharged home.
Allen and colleagues also point out the limitation of our definition of recurrence, which we defined as a clinically significant recurrence within 30 days. We clearly stated this as a constraint of the study. Because this outcome was defined at the outset of the study, we reported our results in this manner so as to maintain the integrity of the study design. However, when we reviewed those patients who lived beyond 90 days (21 of 29), none of them had a clinically significant recurrence develop.
Our study does not refute Allen and colleagues' claim that subxiphoid pericardiostomy has a role in the treatment of pericardial effusions, but highlights echo-guided pericardiocentesis as an effective alternative for certain patients. Our current analysis suggests that patients with simple, nonseptated, noncompartmentalized effusions that are located anteriorly or circumferentially on echocardiogram should be considered for this technique. There is not a great deal of data regarding the management of these patients; therefore we stand by our assertion that pericardiocentesis with extended catheter drainage is a safe treatment option for clinically significant pericardial effusions.
References
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