Late Outcomes Following Controlled Pericardial Drainage for Critical Cardiac Tamponade with Acute Type A Aortic Dissection

Chikashi Nakai ¹, Tomonori Haraguchi ¹, Yasushi Okada ¹, Shinichi Nakayama ², Takuro Tsukube ¹

¹ Japanese Red Cross Kobe Hospital, Kobe, Japan; ² Hyogo Emergency Medical Center, Kobe, Japan;

Date, time and location: 2018.05.25 15:30, Exhibition area, 1st Floor. Zone – C

Abstract

Objectives:Cardiac tamponade with acute type A aortic dissection (AADA) causes fatal outcome.We previously reported excellent outcomes ofpercutaneous pericardial drainagewith control of volume of aspirated pericardial effusion (controlled pericardial drainage: CPD)to stabilize the patients with critical cardiac tamponade who cannot survive until surgery.This study evaluates the early and late outcomes with this approach.

Methods:Between 9/03 and 9/17, 275 patients with AADA were treated surgically, including 72 (26.1%) presented with cardiac tamponade on arrival.Forty-four patients(16%) who were not responded to intravenous volume resuscitation underwent CPD in the emergent room, including 13 patients (4.7%) presented with cardiopulmonary arrest (CPA). The mean age of the patient was77.2(SD 8.8)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 to maintain blood pressure at around 90 mmHg. After CPD, all patients transferred to the operating room and immediate aortic repair was performed subsequently.

Results:In 44 patients, mean systolic blood pressure before CPD was 65.0 + 10.5 mmHg, and blood pressure was elevated significantly in all cases after CPD. Total volume of aspirated pericardial effusion was 46.7 + 59.7 ml, and34 of 44 patients (77.3%) required only 40 ml or less volume of aspiration to improve blood pressure.There were no complications related to CPD, however, 2 patients required open drainage subsequently. None of the patient died preoperatively.All patients underwent aortic repair successfully. Early hospital mortality (<30 days) was 11.3% (5/44), however, there wasno mortality related to PPD.The mean follow-up periods were 45.9 (SD 46.5) months. Cumulative survival rate was 63.4% in 5 years.

Conclusions: Early and late outcomes following controlled pericardial drainagefor critical cardiac tamponade with acute type A aortic dissection weresatisfactory. Timely percutaneous pericardial drainage is strongly recommended