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Risk factors affecting the survival rate in patients with symptomatic pericardial effusion undergoing surgical intervention.
- Source :
-
Interactive cardiovascular and thoracic surgery [Interact Cardiovasc Thorac Surg] 2013 Apr; Vol. 16 (4), pp. 495-500. Date of Electronic Publication: 2012 Dec 18. - Publication Year :
- 2013
-
Abstract
- Objectives: The optimal management and treatment of pericardial effusion are still controversial. There is limited data related to the risk factors affecting survival in these patients. The aim of this study was to determine the risk factors affecting the survival rate of patients with symptomatic pericardial effusion who underwent surgical interventions.<br />Methods: From 2004 to 2011, we retrospectively analysed 153 patients who underwent subxiphoid pericardial window as their surgical intervention to drain pericardial effusions at the National Research Institute of Tuberculosis and Lung diseases (NRITLD). To determine the effects of risk factors on survival rate, demographic data, clinical records, echocardiographic data, computed tomographic and cytopathological findings and also operative information of patients were recorded. Patients were followed annually until the last clinical follow-up (August 2011). To determine the prognostic factors affecting survival, both univariate analysis and multivariate Cox proportional hazards model were utilized.<br />Results: There were 89 men and 64 women with a mean age of 50.3 ± 15.5 years. The most prevalent symptom was dyspnoea. Concurrent malignancies were present in 66 patients. Lungs were the most prevalent primary site for malignancy. The median duration of follow-up was 15 (range 1-85 months). Six-month, 1-year and 18-month survival rates were 85.6, 61.4 and 36.6%, respectively. In a multivariate analysis, positive history of lung cancer (hazard ratio [HR] 2.894, 95% confidence interval [CI] 1.362-6.147, P = 0.006) or other organ cancers (HR 2.315, 95% CI 1.009-50311, P = 0.048), presence of a mass in the computed tomography (HR 1.985, 95% CI 1.100-3.581, P = 0.023), and echocardiographic findings compatible with tamponade (HR 1.745, 95% CI 1.048-2.90 P = 0.032) were the three independent predictors of postoperative death.<br />Conclusions: In the surgical management of pericardial effusion, patients with underlying malignant disease, especially with lung cancer, patients with a detectable invasion of thorax in computed tomography and those with positive echocardiographic findings compatible with tamponade have a poor survival. Therefore, minimally invasive therapies could be considered as a more acceptable alternative for these high-risk patients.
- Subjects :
- Adult
Aged
Cardiac Tamponade etiology
Chi-Square Distribution
Dyspnea etiology
Echocardiography
Female
Humans
Iran
Kaplan-Meier Estimate
Lung Neoplasms complications
Male
Middle Aged
Multivariate Analysis
Neoplasm Invasiveness
Neoplasms diagnosis
Neoplasms mortality
Pericardial Effusion diagnosis
Pericardial Effusion etiology
Pericardial Effusion mortality
Proportional Hazards Models
Retrospective Studies
Risk Assessment
Risk Factors
Survival Rate
Time Factors
Tomography, X-Ray Computed
Treatment Outcome
Neoplasms complications
Pericardial Effusion surgery
Pericardial Window Techniques adverse effects
Pericardial Window Techniques mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1569-9285
- Volume :
- 16
- Issue :
- 4
- Database :
- MEDLINE
- Journal :
- Interactive cardiovascular and thoracic surgery
- Publication Type :
- Academic Journal
- Accession number :
- 23250960
- Full Text :
- https://doi.org/10.1093/icvts/ivs491