Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability Journal Article


Authors: Wagner, P. L.; Mcaleer, E.; Stillwell, E.; Bott, M.; Rusch, V. W.; Schaffer, W.; Huang, J.
Article Title: Pericardial effusions in the cancer population: Prognostic factors after pericardial window and the impact of paradoxical hemodynamic instability
Abstract: Objective: In the cancer population, pericardial effusions are a common and potentially life-threatening occurrence. Although decompression benefits most patients, paradoxical hemodynamic instability (PHI) develops in some, with hypotension and shock in the immediate postoperative period. This study examines paradoxical hemodynamic instability after pericardial window and identifies prognostic factors in patients with cancer who are treated for pericardial effusion. Methods: Retrospective review of 179 consecutive pericardial windows performed for pericardial effusion in a tertiary cancer center over a 5-year period (January 2004 through March 2009). Demographic, surgical, pathologic, and echocardiographic data were analyzed for the end points of paradoxical hemodynamic instability (pressor-dependent hypotension requiring intensive care unit admission) and overall survival. Results: The most common malignancies were lung (44%), breast (20%), hematologic (10%), and gastrointestinal (7%). Overall survival for the group was poor (median, 5 months); patients with hematologic malignant disease fared significantly better than the others (median survival 36 months; P = .008). Paradoxical hemodynamic instability occurred in 19 (11%) patients. These patients were more likely to have evidence of tamponade on echocardiogram (89% vs 56%; P = .005), positive cytology/pathology (68% vs 41%; P = .03), and higher volume drained (674 mL vs 495 mL; P = .003). Overall survival was significantly shorter in those in whom paradoxical hemodynamic instability developed (median survival 35 vs 189 days; hazard ratio = 3; P < .001), and the majority of them (11/19, 58%) did not survive their hospitalization. Conclusions: Postoperative hemodynamic instability after pericardial window portends a grave prognosis. Evidence of tamponade, larger effusion volumes, and positive cytologic findings may predict a higher risk of paradoxical hemodynamic instability and anticipate a need for invasive monitoring and intensive care postoperatively.
Keywords: adult; major clinical study; overall survival; cancer patient; cytology; survival time; intensive care unit; echocardiography; pericardial effusion; hemodynamics; heart tamponade; icu; paradoxical hemodynamic instability; phi; pericardiotomy
Journal Title: Journal of Thoracic and Cardiovascular Surgery
Volume: 141
Issue: 1
ISSN: 0022-5223
Publisher: Mosby Elsevier  
Date Published: 2011-01-01
Start Page: 34
End Page: 38
Language: English
DOI: 10.1016/j.jtcvs.2010.09.015
PROVIDER: scopus
PUBMED: 21092993
DOI/URL:
Notes: --- - "Export Date: 4 March 2011" - "CODEN: JTCSA" - "Source: Scopus"
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MSK Authors
  1. Valerie W Rusch
    865 Rusch
  2. James Huang
    214 Huang
  3. Matthew Bott
    135 Bott
  4. Patrick L Wagner
    4 Wagner