• Inês Cruz, Bruno Stuart, Daniel Caldeira, Gonçalo Morgado, Ana C Gomes, Ana R Almeida, Maria J Loureiro, Isabel João, Carlos Cotrim, and Hélder Pereira.
• Department of Cardiology, Hospital Garcia de Orta, Almada, Portugal inesmariarosariocruz@gmail.com.
• Eur Heart J Acute Cardiovasc Care. 2015 Apr 1; 4 (2): 124-8.

BackgroundCardiac 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.PurposeTo 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 ResultsSingle 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.ConclusionsPreoperative 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.© The European Society of Cardiology 2014.

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