ABSTRACT
Patient S e lection .................................................................................................................... 228 Anesthetic and Surgical Technique o f VATS Pericardiectom y .................................... 229 The A uthors E xperien ce ...................................................................................................... 230 Su m m ary ................................................................................................................................. 231
Pericardial effusions frequently develop in patients with advanced metastatic cancers. Breast and lung cancers account for nearly 70% o f the primary sources.1*3 Small to moderate asymptomatic effusions can be treated medically for a consid erable period, but large effusions with hemodynamic consequences o f tampon ade require an effective drainage procedure.4 5 Pericardiocentesis can provide ef fective decompression when acute tamponade is present in hemodynamically unstable patients. However, these effusions recur rapidly and require definitive surgical drainage.6*9 Recurrent pericardiocentesis increases the risk o f injury to the myocardium, coronary arteries, and other intrathoracic and intra-abdominal organs.10’11
Surgical options available for pericardial decompression include the traditional approaches o f anterior thoracotomy, median sternotomy, and subxiphoid peri cardiotomy. All are associated with considerable morbidity and mortality in de bilitated patients.1213 The recent widespread experience with video-assisted tho racic surgery (VATS) provides another treatment option with less operative trauma for these patients.14*16
PATIENT SELECTION
The patient’s general condition and life expectancy determine the appropriate method of surgical decompression of the pericardium.1117 Many of these patients are terminally ill, with advanced metastatic disease, and are unable to undergo even general anesthesia. This group can be palliated effectively by a simple subxiphoid or left anterior thoracic approach under local anesthesia.318 Some pa tients remain relatively healthy and active with early evidence o f a pericardial ef fusion.19 These patients are excellent candidates for VATS pericardiectomy.
