Resident Medical College of Wisconsin Milwuakee, Wisconsin, United States
Abstract: Introduction/
Objective: Children with postpericardiotomy syndrome may develop hemodynamically significant pericardial effusions warranting drainage by pericardiocentesis or surgical pericardial window. We aimed to compare the efficacy, resource consumption, and safety of these two approaches. We hypothesized that pericardial window would be associated with greater efficacy, less resource utilization, and equivalent safety to pericardiocentesis.
Methods: We performed a retrospective cohort study at two large pediatric cardiac centers with similar case volumes and surgical outcomes, but a different preference for initial drainage procedure. Included were children < 18 y/o who underwent cardiac surgery between 2014 and 2021 and developed postpericardiotomy syndrome-associated pericardial effusions drained via pericardial window or pericardiocentesis. Outcomes included measures of efficacy, safety, and resource utilization. Statistical analyses were conducted using Chi square, Fisher's exact, or Mann-Whitney U tests.
Results: Included were 32 patients who underwent pericardial window and 10 who underwent pericardiocentesis. Baseline characteristics were similar between groups including age, prior cardiac surgery, and type of index operation. Patients in the pericardial window group presented with postpericardiotomy syndrome sooner than those who underwent pericardiocentesis (median 7.5 vs. 14.5 days, p=0.03), tended to undergo earlier intervention (median 8 vs. 16 days, p=0.16), and had more hemodynamic stability just prior to drainage, as the pericardiocentesis group had one case of shock. Otherwise, presentations were similar including ECHO findings prior to intervention, effusion size, and type of effusion. There were no significant differences between groups in days of pericardial tube drainage (median 4 days; p=0.38), complications (2 arrhythmias with pericardial window and 0 with pericardiocentesis; p=1.00), intensive care days (median 1 vs. 1.5 days, respectively; p=0.34) or hospitalization duration (5 vs. 6.5 days, respectively; p=0.65). No patient required subsequent interventional drainage.
Conclusions: For children with postpericardiotomy syndrome with a pericardial effusion warranting drainage, these data suggest that pericardial window and pericardiocentesis have similar efficacy, safety, and resource utilization. A larger multicenter trial is needed to validate these results.
