O. Delgado-Casillas1, P. Gomes-da Silva De Rosenzweig1, J. Vazquez-Mineros1 1Instituto Nacional de Enfermedades Respiratorias, Cardiothoracic Surgery Department, Ciudad De México, CIUDAD DE MEXICO, Mexico
Introduction: Pericardial effusion is the accumulation of fluid in the pericardial sac. The most frequent etiological causes are: inflammatory, infectious, autoimmune, oncological, and traumatic. Pericardial effusion can evolve, altering the patient's hemodynamic stability, and becoming a potentially fatal disease. Thus, requiring urgent intervention in case it becomes a cardiac tamponade. Various factors can aggravate the condition. However, it is not well established which of them represents a greater risk for a fatal outcome.
Methods: We retrospectively reviewed case files from patients who underwent pericardial window for the treatment of pericardial effusion at a single institution from 2007 through 2021. We included patients with chronic pericardial effusion regardless of etiology, who underwent drainage through surgical pericardial window. Demographic data obtained from files was age and gender, while clinical and surgical data gathered were: diagnosis at admission, comorbidities, pericardial window technique, pericardial and pleural fluid quantification in the operating room, and cause of death. Echocardiography information obtained was: calculated effusion, left ventricular ejection fraction (LVEF), pulmonary artery systolic pressure (PASP), and the presence of cardiac cavity collapse (CCC). The primary outcome that was evaluated where predictors for mortality after pericardial drainage. Statistical analysis was carried out with SPSS version 25.0 (SPSS Inc., Chicago, IL, USA). Statistical significance was defined by a confidence interval of 95% (CI) and a p-value of <0.05.
Results: A total of 102 patients were included in the analysis, the median age was 53 years and 53 patients were female. The most common etiology was oncological (78%). In-hospital mortality was 29%. There were a significantly lower LVEF (p = 0.016) in patients who died after the surgical procedure with a comparative mean of 71% (± 8) vs. 66% (± 10). Similarly, the presence of CCC before the procedure was statistically significant for an increase in mortality (p = <0.0001), which was present in 96% (n= 28) of patients who died after surgery. In the patients that died following pericardial window, the median volume of pericardial fluid drained was significantly higher (p = 0.011), although differences in mortality were not present when evaluating the presence or quantification of pleural effusion nor the surgical technique. Chamber collapse and decreased left ventricular ejection fraction are associated with an increase in-hospital death (OR 24.4, 95% CI 3.15-189 p=0.002 and OR .935, 95% CI 0.880-0.97 p=0.31 respectively).
Conclusion: The predictors of mortality in hospitalized patients diagnosed with pericardial effusion are CCC and decreased LVEF. Limitations of our study include the retrospective nature, in addition to absent postsurgical USG, which would have been helpful in determining recurrence if any, or abnormalities in cardiac contractually after surgery