Controlled pericardiocentesis in patients with cardiac tamponade complicating aortic dissection: experience of a centre without cardiothoracic surgery

Eur Heart J Acute Cardiovasc Care. 2015 Apr;4(2):124-8. doi: 10.1177/2048872614549737. Epub 2014 Sep 2.

Abstract

Background: Cardiac tamponade has been reported in 18.7% of patients with acute type A aortic dissection and its presence is associated with worse outcomes. Emergency aortic repair together with intra-operative pericardial drainage is the recommended treatment approach. However, controversy surrounds how to manage patients with haemopericardium and cardiac tamponade who cannot survive until surgery.

Purpose: To describe a case series of patients with critical cardiac tamponade complicating aortic dissection admitted to a hospital without cardiothoracic surgery, and in whom preoperative controlled pericardial drainage was performed.

Methods and results: Single centre retrospective study: during a nine-year period, 21 patients with Stanford type A aortic dissection were admitted at our centre; six of them (28.6%) presented clinical and echocardiographic signs of cardiac tamponade (four males; mean age 58±17 years). In this subgroup, controlled pericardiocentesis was safely performed with no major immediate complications and it was effective in five patients, improving haemodynamic instability and allowing transfer to the operating room.

Conclusions: Preoperative controlled pericardiocentesis can be lifesaving when managing patients with critical cardiac tamponade (pulseless electrical activity or refractory hypotension) complicating acute type A aortic dissection, namely when cardiac surgery is not immediately available.

Keywords: Aortic dissection; cardiac tamponade; pericardiocentesis.

MeSH terms

  • Adult
  • Aged
  • Aneurysm, Dissecting / complications*
  • Aneurysm, Dissecting / etiology
  • Aortic Aneurysm, Thoracic / complications*
  • Cardiac Surgical Procedures*
  • Cardiac Tamponade / diagnostic imaging*
  • Cardiac Tamponade / etiology
  • Cardiac Tamponade / surgery*
  • Echocardiography, Transesophageal / methods
  • Electrocardiography
  • Female
  • Hospital Units
  • Humans
  • Male
  • Middle Aged
  • Patient Selection
  • Pericardial Effusion / diagnostic imaging*
  • Pericardial Effusion / etiology
  • Pericardial Effusion / surgery*
  • Pericardiocentesis / instrumentation
  • Pericardiocentesis / methods*
  • Retrospective Studies
  • Risk Factors
  • Treatment Outcome