HYPOTHESIS: The approach to pericardial window in patients with nontraumatic
pericardial effusion impacts outcome. DESIGN: Retrospective review and comparison of all cases of pericardial window performed over 10 years. Follow-up was to patient death. SETTING: Three hospitals performing
cardiothoracic surgery at a single university. PATIENTS: All patients in whom pericardial window was performed for nontraumatic
pericardial effusion. MAIN OUTCOME MEASURES: Outcomes associated with the subxyphoid approach to pericardial window were compared with those associated with the transthoracic approach. The primary outcome was postsurgical recurrence of
pericardial effusion. Secondary outcomes included operative time, intraoperative and postoperative complications, in-hospital mortality, hospital and
intensive care unit lengths of stay, and days between
surgery and death. RESULTS: Over 10 years, there were 342 patients with procedural codes for pericardial window in the medical record databases of 3 hospitals performing
cardiothoracic surgery at 1 university center. One hundred fifty-one patients were excluded because the operation was performed for trauma, postoperative tamponade, or pericardial
biopsy without
effusion. The results are, therefore, based on the remaining 191 procedures. The subxyphoid approach was used in 78 patients, and the transthoracic approach in 113 patients. Patients were well matched for age (P = .31), sex (P = .05), preoperative tamponade (P = .08), and
comorbidities (P > .05). No differences were observed between the 2 approaches in terms of recurrence of
effusion, operative time, overall intraoperative or postoperative complications, and hospital or
intensive care unit lengths of stay. In-hospital mortality was significantly greater in the subxyphoid group (27 of 78 vs 18 of 113 patients; P = .003). CONCLUSIONS: Over 10 years, there were 191 pericardial windows performed for nontraumatic
pericardial effusions. The subxyphoid and transthoracic approaches were well tolerated by patients, required short operative times, and resulted in similar rates of overall postoperative complications and
intensive care unit and hospital lengths of stay. Recurrence rates were low with both procedures.
