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Systematic review of percutaneous interventions for malignant pericardial effusion
  1. Sohaib A Virk1,
  2. David Chandrakumar1,
  3. Claudia Villanueva2,
  4. Hugh Wolfenden3,
  5. Kevin Liou4,
  6. Christopher Cao1
  1. 1The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia
  2. 2Department of Cardiothoracic Surgery, St George Hospital, Sydney, Australia
  3. 3Department of Cardiothoracic Surgery, Prince of Wales Hospital, Sydney, Australia
  4. 4Department of Cardiology, Prince of Wales Hospital, Sydney, Australia
  5. 5University of New South Wales, Sydney, Australia
  1. Correspondence to Dr Christopher Cao, The Systematic Review Unit, The Collaborative Research (CORE) Group, Sydney, Australia; drchriscao{at}gmail.com

Abstract

The present systematic review assessed the safety and efficacy of percutaneous interventions for malignant pericardial effusion (MPE), with primary endpoint of recurrence of pericardial effusion. Electronic searches of six databases identified thirty-one studies, reporting outcomes following isolated pericardiocentesis (n=305), pericardiocentesis followed by extended catheter drainage (n=486), pericardial instillation of sclerosing agents (n=392) or percutaneous balloon pericardiotomy (PBP) (n=157). Isolated pericardiocentesis demonstrated a pooled recurrence rate of 38.3%. Pooled recurrence rates for extended catheter drainage, pericardial sclerosis and PBP were 12.1%, 10.8% and 10.3%, respectively. Procedure-related mortality ranged from 0.5–1.0% across the percutaneous interventions. Although isolated pericardiocentesis can safely deliver immediate symptomatic relief, subsequent catheter drainage or sclerotherapy are required to minimize recurrence. PBP has been shown to be highly effective and may be particularly useful in managing recurrent effusions. Ultimately, the choice of intervention must be based on the clinical status of patients, their underlying malignancy and the expertise available.

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