In the Catheterization Laboratory, Most Iatrogenic Cardiac Tamponades Require Only Pericardiocentesis: A Single-Center Experience

TL;DR

Most iatrogenic cardiac tamponades after cardiac procedures can be treated with pericardiocentesis, but severe lacerations may require urgent surgery.

Contribution

Identifies high-risk features of iatrogenic cardiac tamponade requiring surgery based on drainage volume and injury type.

Findings

49 out of 51 patients were successfully treated with pericardiocentesis alone.

Patients with lacerated injuries and drainage over 300 mL/hour required open-chest surgery.

Higher initial drainage volumes correlated with the need for surgical intervention.

Abstract

Cardiac tamponade (CT) is a rare but life-threatening
complication of cardiac interventions, requiring immediate pericardial cavity
pressure relief. While pericardiocentesis often suffices, and some cases
necessitate open-chest surgery. This decision is frequently based on individual
physician’s experience. This study aims to identify high-risk CT patients
following cardiac intervention, advocating for early, decisive surgical
intervention.

A retrospective analysis was conducted on 51
patients who developed iatrogenic CT at our center between October 2013 and
October 2023. Patients were classified based on the necessity for open-chest
surgery. The study evaluated a variety of factors, including baseline
characteristics, therapeutic approaches, and outcomes.

Of the
51 patients with iatrogenic CT, 49 patients were successfully treated without
open-chest surgery, with an average immediate drainage volume of 208.2 ±
173.8 mL. In contrast, the two patients requiring open-chest surgery had
significantly higher drainage volumes, exceeding 500 mL, with over 300 mL drained
in the first hour, indicating laceration injuries. Patients not requiring
open-chest surgery demonstrated favorable outcomes.

The
majority of patients with iatrogenic CT and non-lacerated injuries experienced a
favorable prognosis following pericardiocentesis. However, in cases of lacerated
injuries with drainage volume was above 300 mL per hour, pericardiocentesis alone
could not stabilize the hemodynamics due to persistent bleeding. Immediate
surgery may be needed in these cases.