Survival After Surgical Drainage of Malignant Pericardial Effusion

Abstract

Objectives: Management of malignant pericardial effusion (PE) is complex. Cardiac surgeons are not necessarily familiar with or are challenged by the many underlying etiologies. Analyzing risk factors for mortality may help to estimate the benefit of surgery in high-risk patients. Methods: Patients undergoing a surgical pericardiotomy for malignant PE, between 2001 and 2011, were included. The influence of tumor type, disease extension, intra-pericardial tumor infiltration on early mortality and long-term survival as well as freedom from symptoms after drainage, and the use of sclerosing agents on PE recurrence rates was analyzed. Results: PE drainage was performed on 46 patients 12±30months after tumor diagnosis. Malignant diseases were lung cancers (50%), breast cancers (15%), lymphoma and leukemia (13%), cancers of the digestive tract (13%), and others (9%). 80% of patients were symptomatic and symptom relief was achieved in 65%. Nobody died during surgery. Recurrence rate was 4%. Early in-hospital mortality was 22%. After 1year, 29% of patients were alive. Eleven patients (24%) had a complete tumor regression. Metastatic spread (p<0.001), pericardial infiltration (p=0.02), and intra-pericardial Bleomycin (p=0.01) injection were associated with increased mortality. Hematological malignancies had a better prognosis for survival. Conclusion: Surgical pericardiotomy is safe, associated with a low recurrence rate and symptom relief in the majority of dyspneic patients. Intra-pericardial Bleomycin may reduce recurrent effusion but does not ameliorate survival. Long-term survival rate was low with an increased mortality in cases of metastatic spreading, pericardial infiltration, and as the tumor of origin: breast cancers. Leukemic and lymphatic tumors have better prognosis