Pericardial effusion surgery
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Editor-In-Chief: C. Michael Gibson, M.S., M.D. [1]; Associate Editor(s)-in-Chief: Hafiz M. Ahmed, M.D.[2]
Overview
Surgical treatment of pericardial effusion is generally reserved for selected patients in whom percutaneous drainage is insufficient, recurrent effusion or recurrent tamponade occurs after prior pericardiocentesis, or more definitive drainage is required. Surgical options include creation of a pericardial window and, rarely, radical pericardiectomy in highly selected cases.
Indications
- Surgical creation of a pericardial window may be considered in selected patients with recurrent large pericardial effusion and/or recurrent cardiac tamponade despite prior pericardiocentesis.
- Radical pericardiectomy may rarely be considered for recurrent pericardial effusion despite creation of a pericardial window, particularly when medically refractory constrictive pericarditis or recurrent pericarditis is also present.[1]
Surgery
- A pericardial window provides surgical drainage of recurrent or clinically significant pericardial effusion when repeat pericardiocentesis is not sufficient or is not the preferred strategy.
- Radical pericardiectomy is not routine therapy for uncomplicated pericardial effusion and should be reserved for rare, selected patients, especially when recurrent effusion is accompanied by refractory constrictive pericarditis or recurrent pericarditis.[1]
Contraindications
- The 2025 ACC expert consensus statement does not provide a specific list of absolute contraindications to surgical treatment of pericardial effusion. Decisions regarding surgical drainage should be individualized according to clinical status, recurrence pattern, procedural risk, and the presence of associated pericardial disease.[1]
References
- ↑ 1.0 1.1 1.2 Wang TKM, Klein AL, Cremer PC, Imazio M, Kohnstamm S, Luis SA, Mardigyan V, Mukherjee M, Ordovas K, Vakamudi S, Wohlford GF. 2025 Concise Clinical Guidance: An ACC Expert Consensus Statement on the Diagnosis and Management of Pericarditis: A Report of the American College of Cardiology Solution Set Oversight Committee. Journal of the American College of Cardiology. 2025;86(25):2691-2719. https://doi.org/10.1016/j.jacc.2025.05.023.