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Pericardiocentesis versus window formation in malignant pericardial effusion: trends and outcomes
  1. Jaeoh Lee,
  2. Kyu Kim,
  3. Seo-Yeon Gwak,
  4. Hyun-Jung Lee,
  5. Iksung Cho,
  6. Geu-Ru Hong,
  7. Jong-Won Ha,
  8. Chi Young Shim
  1. Yonsei University College of Medicine, Seoul, South Korea
  1. Correspondence to Dr Chi Young Shim, Division of Cardiology, Yonsei University College of Medicine, Seoul 03722, South Korea; cysprs{at}


Objectives Malignant pericardial effusion (MPE) in patients with cancer is associated with poor prognosis. This study aimed to compare clinical outcomes in patients with cancer who underwent pericardiocentesis versus pericardial window formation.

Methods In the present study, 765 consecutive patients with cancer (mean age 58.4 years, 395 men) who underwent pericardial drainage between 2003 and 2022 were retrospectively analysed. All-cause death and MPE recurrence were compared based on the drainage method (pericardiocentesis vs pericardial window formation) and time period (period 1: 2003–2012; period 2: 2013–2022).

Results Pericardiocentesis was performed in 639 (83.5%) patients and pericardial window formation in 126 (16.5%). There was no difference in age, sex distribution, proportion of metastatic or relapsed cancer, and chemotherapy status between the pericardiocentesis and pericardial window formation groups. Difference was not found in all-cause death between the two groups (log-rank p=0.226) regardless of the period. The pericardial window formation group was associated with lower MPE recurrence than the pericardiocentesis group (6.3% vs 18.0%, log-rank p=0.001). This advantage of pericardial window formation was more significant in period 2 (18.1% vs 1.3%, log-rank p=0.005). In multivariate analysis, pericardial window formation was associated with lower MPE recurrence (HR: 0.31, 95% CI: 0.15 to 0.63, p=0.001); younger age, metastatic or relapsed cancer, and positive malignant cells in pericardial fluid were associated with increased recurrence.

Conclusion In patients undergoing pericardial drainage for MPE, pericardial window formation showed mortality outcomes comparable with pericardiocentesis and was associated with lower incidence of MPE recurrence.

  • Pericardial Effusion
  • Cardiac Tamponade
  • Cardiac Surgical Procedures

Data availability statement

Data are available upon reasonable request.

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Data availability statement

Data are available upon reasonable request.

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  • Contributors JL—data curation, formal analysis, visualisation, writing (original draft) and writing (review and editing). KK—conceptualisation, formal analysis, methodology, writing (original draft), writing (review and editing) and visualisation. S-YG—data curation and investigation. H-JL—data curation and investigation. IC—data curation and investigation. G-rH—data curation, supervision and validation. J-WH—supervision and validation. CYS—conceptualisation, funding acquisition, methodology, project administration, supervision, validation, visualisation, writing (original draft) and writing (review and editing). CYS is the guarantor.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.