• Adam J Saltzman, Yehuda E Paz, A Garvey Rene, Philip Green, Ahmed Hassanin, Michael G Argenziano, Leroy Rabbani, and George Dangas.
• Massachusetts General Hospital, Division of Cardiology, 55 Fruit Street, Boston, MA 02114 USA. ajsaltzman@partners.org

ObjectiveWe sought to investigate the outcomes for different treatments of pericardial effusions.BackgroundThe optimal initial management for symptomatic pericardial effusions remains controversial.MethodsWe performed a 3-year retrospective, single-institution study comparing open surgical drainage to percutaneous pericardiocentesis for symptomatic pericardial effusions.ResultsBetween 2007 and 2009, a total of 193 patients underwent an initial drainage procedure for a pericardial effusion (n = 121 [62.7%] pericardiocentesis; n = 72 [37.3%] open surgical drainage). Compared to those treated with pericardiocentesis, treatment with open surgical drainage was associated with a higher complication rate (4.9% vs 26.4%; P<.0001; odds ratio [OR], 6.9; 95% confidence interval [CI], 2.6-18.2). Treatment with pericardiocentesis was associated with a higher rate of repeat procedures to drain a recurrent effusion compared to open surgical drainage (28.9% vs 2.8%; P<.0001; OR, 14.2; 95% CI, 3.3-61.3). Thirty-day mortality (19.8% surgical group vs 18.1% pericardiocentesis group; P=.8) and long-term survival (P=.4) did not differ between the groups.ConclusionThere is no significant difference in overall mortality between open surgical drainage and percutaneous pericardiocentesis for symptomatic pericardial effusions. There may be more procedural complications following surgical drainage of a pericardial effusion, and a greater need for repeat procedures if the effusion is drained using pericardiocentesis.

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