Thoracoscopic versus subxiphoid pericardial window in patients with end-stage renal disease

Abstract

Background

Pericardial effusion is a common problem in patients with end-stage renal disease (ESRD). There are many surgical approaches to perform a pericardial window in those patients. This study compared the safety and efficacy of VATS and subxiphoid approaches in performing a pericardial window for pericardial effusion in patients with ESRD.

Methods

From February 2015 to March 2017, a prospective study included a total number of 30 patients of ESRD who were prepared for pericardial window. Patients were randomly divided into two groups: group A (15 patients who underwent VATS pericardial window), and group B (15 patients who underwent subxiphoid pericardial window). Patients were followed-up for 12 months postoperatively.

Results

Both procedures were safe and effective in the management of pericardial effusion. Preoperative data showed no significant difference between both groups. In VATS group, there were significant increased operative times (p-value = 0.031) but with a significantly shorter length of hospital stay (p-value = 0.037) when compared to the subxiphoid group. In both groups, no mortality was recorded. Recurrent pericardial effusion was detected in 5 patients (33.3%) in the subxiphoid group while it was detected in 1 patient (6.7%) in VATS group (p-value = 0.169). VATS approach was the independent predictor of freedom from recurrence (hazard ratio: 0.054; p-value = 0.020).

Conclusions

VATS is a safe and effective procedure in the management of pericardial effusion in patients with ESRD. VATS approach decreased total length of hospital stay and decreased the incidence of recurrence of pericardial effusion.