Ann Thorac Surg 1994;57:289-292
© 1994 The Society of Thoracic Surgeons
Pericardioperitoneal shunt: An alternative treatment for malignant pericardial effusion
Nan Wang, MD*,
J.Randall Feikes, MD,
Thomas Mogensen, BS,
Edwin E. Vyhmeister, MD,
Leonard L. Bailey, MD
Division of Cardiothoracic Surgery, Department of Surgery, Loma Linda University Medical Center, Loma Linda, California, USA
* Address reprint requests to Dr Wang, Department of Surgery, Lama Linda University Medical Center, 11234 Anderson St, Loma Linda, CA 92354.
The treatment of 37 consecutive cases of symptomatic malignant pericardial effusion over a period of 13 years was retrospectively analyzed. The most common diagnoses were lung cancer (59%) and breast cancer (11%). In the most recent 4 patients, the Denver pleuroperitoneal shunt was used to drain the pericardial effusion into the peritoneal cavity. In each case, the procedure was performed under local anesthesia, and the patient was discharged 2 to 4 days later without complications. Three of the patients subsequently died of the disease process without evidence of cardiac failure or tamponade during 6-month follow-up. The more traditionl events of pericardial drainage, the subxiphoid approach (14 patients) and the anterior thotacotomy approach (19 patients), were associated with higher postoperative morbidity (21% and 53%, respectively) and mortality (7% and 42%, respectively). Because of the small number of patients treated by pericardioperitoneal shunting, a significant difference was demonstrated only in the length of hospital stay (shunt, 2.8 ± 0.5 days; subxiphoid, 11.2 ± 4.6 days; thoracotomy, 14.9 ± 6.1 days). Median survivals were essentially the same (shunt, 3.5 months; subxiphoid, 2.7 months; thoracotomy, 1.2 months). It is apparent that the pericardioperitoneal shunt, although a much simpler procedure, can accomplish similar palliation effectively in the treatment of malignant pericardial effusion.
Presented at the Poster Session of the Twenty-ninth Annual Meeting of The Society of Thoracic Surgeons, San Anlonio. TX. Jan 25–27, 1993.
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