Original Investigation|Articles in Press

Comparing Outcomes of CT-Guided Percutaneous Pericardial Drainage with Surgical Pericardial Window in Patients with Symptomatic Pericardial Effusions

Published:March 14, 2023DOI:

      Rationale and Objectives

      To compare short-term outcomes of CT-guided percutaneous pericardial drainage (PPD) versus subxiphoid surgical pericardial window (PW) drainage and analyze the risk factors associated with their outcomes.

      Materials and Methods

      A retrospective chart review of patients who underwent either percutaneous drainage with drainage catheter placement or PW with surgical drain placement for symptomatic pericardial effusion between January 1, 2006 and August 31, 2016 was performed after institutional review board approval (decision number 16-783). The primary objective was to test for associations between the short-term (≤30 days post procedure) complication and recurrence rates in patients with symptomatic pericardial effusions. The secondary objectives were to test for associations between short-term complications with changes in vital signs.


      Of the 257 procedures included in the final analysis, 142 were in the percutaneous drainage group. Short-term complication rate was significantly greater (p < 0.001) in patients undergoing PW, 17% (19/114), as compared with PPD, 2% (3/142). The estimated odds of having complications in the PW cohort was 9 times greater than the percutaneous drainage cohort (OR = 9.3, 95% CI:  2.7-32.3). No significant difference was observed between whether or not a patient experienced a short-term recurrence and any of the explanatory variables (patient demographics, imaging, and vital signs).


      CT-guided PPD is a safer alternative to surgical PW as it leads to fewer complications without a significant difference in recurrence rate of pericardial effusion.

      Key Words


      CT (computed tomography), CPT (current procedural terminology), DBP (diastolic blood pressure), Fr (French), HR (heart rate), IQR (interquartile rank), IR (interventional radiology), MAP (mean arterial pressure), OR (odds ratio), PPD (percutaneous pericardial drainage), PW (pericardial window), SBP (systolic blood pressure), US (ultrasound)
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        • Vakamudi S
        • Ho N
        • Cremer PC.
        Pericardial effusions: causes, diagnosis, and management.
        Prog Cardiovasc Dis. 2017; 59: 380-388
        • Azarbal A
        • LeWinter MM.
        Pericardial effusion.
        Cardiol Clin. 2017; 35: 515-524
        • Willner DA
        • Kiel J.
        Pericardial effusion.
        StatPearls, Treasure Island, FL2020
        • Reddy PS
        • Curtiss EI.
        Cardiac tamponade.
        Cardiol Clin. 1990; 8: 627-637
        • Palacios IF.
        Pericardial effusion and tamponade.
        Curr Treat Options Cardiovasc Med. 1999; 1: 79-89
        • Sagrista-Sauleda J
        • Merce AS
        • Soler-Soler J.
        Diagnosis and management of pericardial effusion.
        World J Cardiol. 2011; 3: 135-143
        • Maisch B
        • Seferovic PM
        • Ristic AD
        • et al.
        Guidelines on the diagnosis and management of pericardial diseases executive summary; The Task force on the diagnosis and management of pericardial diseases of the European society of cardiology.
        Eur Hear J. 2004; 25: 587-610
        • Kopecky SL
        • Callahan JA
        • Tajik AJ
        • Seward JB.
        Percutaneous pericardial catheter drainage: report of 42 consecutive cases.
        Am J Cardiol. 1986; 58: 633-635
        • McDonald JM
        • Meyers BF
        • Guthrie TJ
        • et al.
        Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion.
        Ann Thorac Surg. 2003; 76 (discussion 816): 811-815
        • Saltzman AJ
        • Paz YE
        • Rene AG
        • et al.
        Comparison of surgical pericardial drainage with percutaneous catheter drainage for pericardial effusion.
        J Invasive Cardiol. 2012; 24: 590-593
        • Horr SE
        • Mentias A
        • Houghtaling PL
        • et al.
        Comparison of outcomes of pericardiocentesis versus surgical pericardial window in patients requiring drainage of pericardial effusions.
        Am J Cardiol. 2017; 120: 883-890
        • Ingber RB
        • Al-roubaie M
        • Lodhi U.
        CT-guided pericardial drainage : a safe and viable alternative to ultrasound-guided drainage.
        Semin Intervent Radiol. 2022; 39: 329-333
        • Lindenberger M
        • Kjellberg M
        • Karlsson E
        • et al.
        Pericardiocentesis guided by 2-D echocardiography: the method of choice for treatment of pericardial effusion.
        J Intern Med. 2003; 253: 411-417
        • Palmer SL
        • Kelly PD
        • Schenkel FA
        • et al.
        CT-guided tube pericardiostomy: a safe and effective technique in the management of postsurgical pericardial effusion.
        Am J Roentgenol. 2009; 193: 314-320
        • Ristic AD
        • Imazio M
        • Adler Y
        • et al.
        Triage strategy for urgent management of cardiac tamponade: a position statement of the European Society of Cardiology Working Group on myocardial and pericardial diseases.
        Eur Hear J. 2014; 35: 2279-2284
        • Khalilzadeh O
        • Baerlocher MO
        • Shyn PB
        • et al.
        Proposal of a new adverse event classification by the society of interventional radiology standards of practice committee.
        J Vasc Interv Radiol. 2017; 28: 1432-1437.e3
        • Adler Y
        • Charron P
        • Imazio M
        • et al.
        2015 ESC Guidelines for the diagnosis and management of pericardial diseases: the task force for the diagnosis and management of pericardial diseases of the European Society of Cardiology (ESC) endorsed by: the European Association for Cardio-Thoracic Surg.
        Eur Hear J. 2015; 36: 2921-2964
        • Allen KB
        • Faber LP
        • Warren WH
        • et al.
        Pericardial effusion: subxiphoid pericardiostomy versus percutaneous catheter drainage.
        Ann Thorac Surg. 1999; 67: 437-440
        • Petcu CP
        • Droc I.
        The efficiency of surgical subxiphoid pericardial drainage and percutaneous pericardial drainage in pericardial effusions associated with cardiac tamponade.
        Chir. 2013; 108: 226-233
        • Patel N
        • Rafique AM
        • Eshaghian S
        • et al.
        Retrospective comparison of outcomes, diagnostic value, and complications of percutaneous prolonged drainage versus surgical pericardiotomy of pericardial effusion associated with malignancy.
        Am J Cardiol. 2013; 112: 1235-1239
        • Maggiolini S
        • Gentile G
        • Farina A
        • et al.
        Safety, efficacy, and complications of pericardiocentesis by real-time echo-monitored procedure.
        Am J Cardiol. 2016; 117: 1369-1374
        • Klein S V
        • Afridi H
        • Agarwal D
        • et al.
        CT directed diagnostic and therapeutic pericardiocentesis: 8-year experience at a single institution.
        Emerg Radiol. 2005; 11: 353-363
        • Pepi M
        • Muratori M
        • Barbier P
        • et al.
        Pericardial effusion after cardiac surgery: incidence, site, size, and haemodynamic consequences.
        Br Hear J. 1994; 72: 327-331
        • Weitzman LB
        • Tinker WP
        • Kronzon I
        • et al.
        The incidence and natural history of pericardial effusion after cardiac surgery–an echocardiographic study.
        Circulation. 1984; 69: 506-511
        • Duvernoy O
        • Larsson SG
        • Persson K
        • et al.
        Pericardial effusion and pericardial compartments after open heart surgery. An analysis by computed tomography and echocardiography.
        Acta Radiol. 1990; 31: 41-46