Abstract 15189: Impact of Preoperative Percutaneous Pericardial Drainage on Critical Cardiac Tamponade with Acute Type A Aortic Dissection
Objectives: Cardiac tamponade is associated with fatal outcome for the patients with acute type A aortic dissection (AADA), and presence of cardiac tamponade should prompt urgent aortic repair. However, treatment of the patient with critical cardiac tamponade who cannot survive until surgery remains unclear. We analyzed our experience of emergent preoperative percutaneous pericardial drainage (PPD) managing critical cardiac tamponade in the context of AADA.
Methods: Between 9/03 and 5/11, 175 patients with AADA were treated surgically, including 43 (24.6%) presented with cardiac tamponade on arrival. Eighteen patients (10.3%), who were not responded to intravenous volume resuscitation, underwent PPD in the emergent room. The mean age of the patient was 64 years. An 8-French pigtail drainage catheter was inserted under ultrasound guidance, and drainage volume was controlled by means of several cycles of intermittent drainage (using 10 ml syringe) to maintain blood pressure at around 90 mmHg. After PPD, all patients transferred to the operating room and immediate aortic repair was performed subsequently. The Effect of PPD and in-hospital mortality were analyzed.
Results: In 18 patients, mean systolic blood pressure before PPD was 64.3 + 8.2 mmHg. Blood pressure was elevated significantly in all cases after PPD, and the mean systolic blood pressure after PPD was 94.8 + 10.5 mmHg, and increase in systolic pressure was 30.5 + 11.7 mmHg. Total volume of aspirated pericardial effusion was 40.1 + 30.6 ml, and 10 of 18 patients required only 30 ml or less volume of aspiration to improve blood pressure. There were no complications related to PPD, and none of the patient died preoperatively. All patients underwent aortic repair successfully. In-hospital mortality of the patient was 16.7% (3/18), however, there was no mortality related to PPD.
Conclusions: Preoperative PPD with control of volume of aspirated pericardial effusion is a safe and effective procedure for AADA complicated by critical cardiac tamponade. Repeated aspiration of small volume of fluids should be enough to stabilize circulation of the patient until urgent aortic repair.for AADA complicated by severe cardiac tamponade. Timely percutaneous pericardial drainage is strongly recommended.
- © 2011 by American Heart Association, Inc.