Initial management of severe malignant pericardial effusion with percutaneous balloon pericardiotomy

Purpose: Malignant pericardial effusion (MPE) is associated with adverse outcomes and presents a high rate of recurrence after pericardiocentesis. Various approaches have been reported for prevention of recurrences. However most of them are associated with significant morbidity or even mortality and required unnecessarily prolonged hospital stay. We sought to confirm the efficacy of percutaneous balloon pericardiotomy (PPB) as the initial treatment of choice for MPE. Methods: Retrospective analysis of the clinical, echocardiographic and follow-up characteristics of a consecutive series of PPB carried out in a single center in patients with advanced cancer. Results: Twenty-one PPB were performed in 19 patients with a mean age of 65±15 years. Seventeen patients had pathologically confirmed metastatic neoplastic disease and in another two patients there was a high radiological suspicion of it. Three patients had previously required pericardiocentesis, and in the remaining patients PPB constituted the first treatment for the MPE. All patients had a severe (>20mm) circumferential effusion and only one patient did not have evidence of hemodynamic compromise on echocardiography. In all cases the procedure was initially successful, there were no acute complications, and it was well tolerated at the first attempt. There were no infectious complications, and just one patient developed a large pleural effusion that did not require treatment. During the follow-up (median 74 [IQR 31.5-207.5] days), four patients required a new pericardial procedure: 2 elective pericardial window surgeries and 2 new PPB. Conclusions: PPB is a simple, safe procedure that can be effective in the prevention of recurrences in many patients with MPE. Based on the results and the poor prognosis of these patients we believe that PPB might be considered the initial treatment of choice for most MPE.