{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T21:41:29Z","timestamp":1792791689869,"version":"4.5.0"},"reference-count":54,"publisher":"MDPI AG","issue":"14","license":[{"start":{"date-parts":[[2025,7,14]],"date-time":"2025-07-14T00:00:00Z","timestamp":1752451200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JCM"],"abstract":"<jats:p>Objectives: Pericardial effusion is the accumulation of excess fluid in the pericardial sac. The etiology is multi-factorial and different techniques are used for management, including subxiphoid approaches, anterior and lateral thoracotomies, video-assisted thoracic surgery (VATS), and percutaneous pericardiocentesis. We evaluate the surgical management strategies for pericardial effusion and their outcomes in this systematic review. Methods: A systematic literature review was performed to identify studies on the surgical management of pericardial effusion from inception to February 2024 using PubMed, Cochrane, and Scopus. Articles were independently assessed by two reviewers, with discrepancies resolved by the senior author. Articles were considered for inclusion if they described different pericardial effusion surgical management techniques. Baseline patient characteristics and procedural and outcome variables were extracted. Results: A total of 27 studies comprising 2773 patients were evaluated. The median age was 56.2 years (interquartile range 47\u201362.2). The most common etiologies of pericardial effusion were malignancy (31.0%), post-cardiac surgery (18.7%), and idiopathic (15.4%). Other causes included uremia (9.6%), infection (9.6%), and autoimmune disease (4.2%). The subxiphoid pericardial window was the most common approach (82.6%), followed by anterior and lateral thoracotomy (12.0%), and median sternotomy (0.6%). At median follow-up of 24 months, the most frequent post-procedural complications were recurrence of effusion (10.5%), arrhythmias (2.7%), and pneumonia (0.7%). Conclusions: Subxiphoid pericardial window is the most common approach for draining pericardial effusions. Prognosis depends on both the underlying etiology and the chosen drainage strategy. Treatment should be tailored to individual patients, considering patient comorbidities and the specific etiology.<\/jats:p>","DOI":"10.3390\/jcm14144985","type":"journal-article","created":{"date-parts":[[2025,7,15]],"date-time":"2025-07-15T09:45:52Z","timestamp":1752572752000},"page":"4985","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Surgical Management Strategies for Pericardial Effusion\u2014A Systematic Review"],"prefix":"10.3390","volume":"14","author":[{"ORCID":"https:\/\/orcid.org\/0009-0001-6637-596X","authenticated-orcid":false,"given":"Ruman K.","family":"Qasba","sequence":"first","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Busra","family":"Cangut","sequence":"additional","affiliation":[{"name":"Icahn School of Medicine at Mount Sinai, New York, NY 10029, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Amnah","family":"Alhazmi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Javeria","family":"Naseer","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ayesha","family":"Mubasher","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sriharsha","family":"Talapaneni","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maurish","family":"Fatima","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Afsheen","family":"Nasir","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shanzil","family":"Shafqat","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shreya","family":"Avilala","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4954-4685","authenticated-orcid":false,"given":"Irbaz","family":"Hameed","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, Department of Surgery, Yale University School of Medicine, New Haven, CT 06510, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,7,14]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"2921","DOI":"10.1093\/eurheartj\/ehv318","article-title":"2015 ESC Guidelines for the diagnosis and management of pericardial diseases","volume":"36","author":"Adler","year":"2015","journal-title":"Eur. Heart J."},{"key":"ref_2","first-page":"36","article-title":"Mortality in patients treated for tuberculous pericarditis in sub-Saharan Africa","volume":"98","author":"Mayosi","year":"2008","journal-title":"S. Afr. Med. J. Suid-Afr. Tydskr. Vir. Geneeskd."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"380","DOI":"10.1016\/j.pcad.2016.12.009","article-title":"Pericardial Effusions: Causes, Diagnosis, and Management","volume":"59","author":"Vakamudi","year":"2017","journal-title":"Prog. Cardiovasc. Dis."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"1186","DOI":"10.1093\/eurheartj\/ehs372","article-title":"Management of pericardial effusion","volume":"34","author":"Imazio","year":"2013","journal-title":"Eur. Heart J."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"104142","DOI":"10.1016\/j.amsu.2022.104142","article-title":"Diagnosis, treatment, and management of pericardial effusion-review","volume":"80","author":"Yamani","year":"2022","journal-title":"Ann. Med. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"1619","DOI":"10.1007\/s11886-022-01773-7","article-title":"Pericardiectomy and Pericardial Window for the Treatment of Pericardial Disease in the Contemporary Era","volume":"24","author":"Oh","year":"2022","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"381","DOI":"10.1016\/S0003-4975(10)62862-7","article-title":"Clinical Experience with Subxiphoid Drainage of Pericardial Effusions","volume":"48","author":"Palatianos","year":"1989","journal-title":"Ann. Thorac. Surg."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"777","DOI":"10.1097\/00000658-199312000-00012","article-title":"A Prospective Trial of Subxiphoid Pericardiotomy in the Diagnosis and Treatment of Large Pericardial Effusion A Follow-Up Report","volume":"218","author":"Trigt","year":"1993","journal-title":"Ann. Surg."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"546","DOI":"10.1016\/S0022-5223(95)70287-3","article-title":"Subxiphoid pericardial drainage for pericardial tamponade","volume":"109","author":"Moores","year":"1995","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"297","DOI":"10.1177\/021849239900700410","article-title":"Subxiphoid Approach for Treatment of Pericardial Effusion","volume":"7","author":"Farsak","year":"1999","journal-title":"Asian Cardiovasc. Thorac. Ann."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1177\/147323000303100409","article-title":"Clinical Experience with Subxiphoid Pericardiostomy in the Management of Pericardial Effusions: A Study of 240 Cases","volume":"31","author":"Becit","year":"2003","journal-title":"J. Int. Med. Res."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"1113","DOI":"10.1001\/archinte.1986.00360180105017","article-title":"Subxiphoid pericardiostomy for hemodialysis-associated pericardial effusion","volume":"146","author":"Daugirdas","year":"1986","journal-title":"Arch. Intern. Med."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"242","DOI":"10.1378\/chest.124.1.242","article-title":"Risk factors affecting the survival of patients with pericardial effusion submitted to subxiphoid pericardiostomy","volume":"124","author":"Dosios","year":"2003","journal-title":"Chest"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/S1010-7940(99)00204-3","article-title":"Pericardoscopy for primary management of pericardial effusion in cancer patients","volume":"16","author":"Porte","year":"1999","journal-title":"Eur. J. Cardio-Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"1075","DOI":"10.1016\/0002-9149(92)90866-W","article-title":"Diagnosis and management (by subxiphoid pericardiotomy) of large pericardial effusions causing cardiac tamponade","volume":"69","author":"Wall","year":"1992","journal-title":"Am. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"430","DOI":"10.1016\/1010-7940(91)90189-Q","article-title":"Surgical treatment of large pericardial effusions Etiology and long-term survival","volume":"5","author":"Olsen","year":"1991","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"123","DOI":"10.1186\/1477-7819-10-123","article-title":"Surgical properties and survival of a pericardial window via left minithoracotomy for benign and malignant pericardial tamponade in cancer patients","volume":"10","author":"Celik","year":"2012","journal-title":"World J. Surg. Oncol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"482","DOI":"10.4103\/jmas.jmas_337_22","article-title":"Awake uniportal video-assisted thoracoscopic surgery for the management of pericardial effusion","volume":"19","author":"Erdem","year":"2023","journal-title":"J. Minimal Access Surg."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"607","DOI":"10.1016\/j.athoracsur.2005.02.068","article-title":"Video-assisted thoracoscopic pericardial window for diagnosis and management of pericardial effusions","volume":"80","author":"Georghiou","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"375","DOI":"10.1308\/003588415X14181254789925","article-title":"Anterior parasternal approach for creation of a pericardial window","volume":"97","author":"Altman","year":"2015","journal-title":"Ann. R. Coll. Surg. Engl."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"165","DOI":"10.1007\/BF02303633","article-title":"Eleven years\u2019 experience with pericardial-peritoneal window in the management of malignant and benign pericardial effusions","volume":"2","author":"Olson","year":"1995","journal-title":"Ann. Surg. Oncol."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"212","DOI":"10.1016\/j.jescts.2018.07.002","article-title":"Thoracoscopic versus subxiphoid pericardial window in patients with end-stage renal disease","volume":"26","author":"Salim","year":"2018","journal-title":"J. Egypt. Soc. Cardio-Thorac. Surg."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"506","DOI":"10.1016\/S0022-5223(19)38563-0","article-title":"Surgical management of effusive pericardial disease","volume":"90","author":"Piehler","year":"1985","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"76","DOI":"10.1002\/1097-0142(19910101)67:1<76::AID-CNCR2820670115>3.0.CO;2-6","article-title":"Surgical management of pericardial effusion in patients with malignancies. Comparison of subxiphoid window versus pericardiectomy","volume":"67","author":"Park","year":"1991","journal-title":"Cancer"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1377","DOI":"10.1002\/1097-0142(19951015)76:8<1377::AID-CNCR2820760813>3.0.CO;2-M","article-title":"Malignancy-related pericardial effusion. 127 cases from the roswell park cancer institute","volume":"76","author":"Wilkes","year":"1995","journal-title":"Cancer"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"437","DOI":"10.1016\/S0003-4975(98)01192-8","article-title":"Pericardial effusion: Subxiphoid pericardiostomy versus percutaneous catheter drainage","volume":"67","author":"Allen","year":"1999","journal-title":"Ann. Thorac. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"2013","DOI":"10.1016\/j.athoracsur.2005.05.059","article-title":"Comparative Study of Subxiphoid Versus Video-Thoracoscopic Pericardial \u201cWindow\u201d","volume":"80","author":"Kucharczuk","year":"2005","journal-title":"Ann. Thorac. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"9","DOI":"10.1016\/j.jss.2020.01.014","article-title":"Mid-Term Efficacy of Subxiphoid Versus Transpleural Pericardial Window for Pericardial Effusion","volume":"252","author":"Balla","year":"2020","journal-title":"J. Surg. Res."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"811","DOI":"10.1016\/S0003-4975(03)00665-9","article-title":"Comparison of open subxiphoid pericardial drainage with percutaneous catheter drainage for symptomatic pericardial effusion","volume":"76","author":"McDonald","year":"2003","journal-title":"Ann. Thorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"883","DOI":"10.1016\/j.amjcard.2017.06.003","article-title":"Comparison of Outcomes of Pericardiocentesis Versus Surgical Pericardial Window in Patients Requiring Drainage of Pericardial Effusions","volume":"120","author":"Horr","year":"2017","journal-title":"Am. J. Cardiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"174","DOI":"10.1510\/icvts.2010.243725","article-title":"The pericardial window: Is a video-assisted thoracoscopy approach better than a surgical approach?","volume":"12","author":"Muhammad","year":"2011","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"135","DOI":"10.4330\/wjc.v3.i5.135","article-title":"Diagnosis and management of pericardial effusion","volume":"3","year":"2011","journal-title":"World J. Cardiol."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1007\/s00059-011-3428-5","article-title":"Causes of moderate to large pericardial effusion requiring pericardiocentesis in 140 Han Chinese patients","volume":"37","author":"Ma","year":"2012","journal-title":"Herz"},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"1119","DOI":"10.1016\/j.jacc.2015.06.1332","article-title":"Outcomes of Cancer Patients Undergoing Percutaneous Pericardiocentesis for Pericardial Effusion","volume":"66","author":"Iliescu","year":"2015","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"918","DOI":"10.1007\/s00246-021-02563-8","article-title":"Anatomic Approach and Outcomes in Children Undergoing Percutaneous Pericardiocentesis","volume":"42","author":"Myers","year":"2021","journal-title":"Pediatr. Cardiol."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"331","DOI":"10.1080\/14017431.2022.2111463","article-title":"Percutaneous balloon pericardiotomy: Efficacy in a series of malignant and nonmalignant cases","volume":"56","author":"Sigusch","year":"2022","journal-title":"Scand. Cardiovasc. J."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"429","DOI":"10.1016\/S0025-6196(11)62211-8","article-title":"Consecutive 1127 Therapeutic Echocardiographically Guided Pericardiocenteses: Clinical Profile, Practice Patterns, and Outcomes Spanning 21 Years","volume":"77","author":"Tsang","year":"2002","journal-title":"Mayo Clin. Proc."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1016\/0002-9149(85)91023-9","article-title":"Primary acute pericardial disease: A prospective series of 231 consecutive patients","volume":"56","year":"1985","journal-title":"Am. J. Cardiol."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"106","DOI":"10.1016\/S0002-9343(98)00192-2","article-title":"Should pericardial drainage be performed routinely in patients who have a large pericardial effusion without tamponade?","volume":"105","year":"1998","journal-title":"Am. J. Med."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"59","DOI":"10.1001\/jama.1994.03520010071035","article-title":"Treatment of Malignant Pericardial Effusion","volume":"272","author":"Vaitkus","year":"1994","journal-title":"JAMA J. Am. Med. Assoc."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"19","DOI":"10.4103\/jmas.jmas_144_22","article-title":"Safety and feasibility of thoracoscopic pericardial window in recurrent pericardial effusion\u2014A single-centre experience","volume":"20","author":"Pulle","year":"2024","journal-title":"J. Minimal Access Surg."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"1422","DOI":"10.1016\/S0003-4975(97)00992-2","article-title":"Pericardiocentesis and Intrapericardial Sclerosis: Effective Therapy for Malignant Pericardial Effusions","volume":"64","author":"Girardi","year":"1997","journal-title":"Ann. Thorac. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"1072","DOI":"10.1016\/S0894-7317(98)70159-2","article-title":"Percutaneous Echocardiographically Guided Pericardiocentesis in Pediatric Patients: Evaluation of Safety and Efficacy","volume":"11","author":"Tsang","year":"1998","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"637","DOI":"10.1016\/S0022-5223(96)70046-6","article-title":"Pericardial sclerosis as the primary management of malignant pericardial effusion and cardiac tamponade","volume":"112","author":"Maher","year":"1996","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"1820","DOI":"10.1016\/j.amjcard.2011.07.057","article-title":"Frequency of Recurrence of Pericardial Tamponade in Patients with Extended Versus Nonextended Pericardial Catheter Drainage","volume":"108","author":"Rafique","year":"2011","journal-title":"Am. J. Cardiol."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"99","DOI":"10.1016\/1010-7940(91)90007-7","article-title":"Pericardial drainage: Subxiphoid vs. transthoracic approach","volume":"5","author":"Naunheim","year":"1991","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/s13019-016-0466-3","article-title":"Contemporary outcomes after pericardial window surgery: Impact of operative technique","volume":"11","author":"Langdon","year":"2016","journal-title":"J. Cardiothorac. Surg."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Del Portillo-Navarrete, J.H., Pizano, A., Benavides, J., Palacio, A.M., Moreno-Medina, K., Cabrales, J., and Echeverri, D. (2022). Unveiling the causes of pericardial effusion in a contemporary case series of pericardiocentesis in Latin America. Sci. Rep., 12, Erratum in Sci. Rep. 2022, 12, 19517.","DOI":"10.1038\/s41598-022-19339-6"},{"key":"ref_49","doi-asserted-by":"crossref","first-page":"60","DOI":"10.1007\/s11886-020-01324-y","article-title":"Overview of Optimal Techniques for Pericardiocentesis in Contemporary Practice","volume":"22","author":"Luis","year":"2020","journal-title":"Curr. Cardiol. Rep."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"264","DOI":"10.1001\/jama.1956.02970210004002","article-title":"THE ELECTROCARDIOGRAM AS A SAFEGUARD IN PERICARDIOCENTESIS","volume":"162","author":"Bishop","year":"1956","journal-title":"J. Am. Med. Assoc."},{"key":"ref_51","first-page":"63","article-title":"Sinus node dysfunction occurring immediately after pericardiocentesis","volume":"24","author":"Cotoi","year":"1987","journal-title":"Physiol. Bucar."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"77","DOI":"10.1007\/BF00254130","article-title":"Persistent ST-segment elevation following pericardiocentesis: Caution with thrombolytic therapy","volume":"14","author":"Hsia","year":"1988","journal-title":"Intensive Care Med."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"1121","DOI":"10.1016\/j.cjca.2023.02.003","article-title":"Chronic pericardial effusion: Causes and management","volume":"39","author":"Lazaros","year":"2023","journal-title":"Can. J. Cardiol."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"967","DOI":"10.1016\/j.cjco.2024.05.003","article-title":"Malignant Pericardial Effusion: A Systematic Review","volume":"6","author":"Mudra","year":"2024","journal-title":"CJC Open"}],"container-title":["Journal of Clinical Medicine"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4985\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T18:09:57Z","timestamp":1760033397000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2077-0383\/14\/14\/4985"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,7,14]]},"references-count":54,"journal-issue":{"issue":"14","published-online":{"date-parts":[[2025,7]]}},"alternative-id":["jcm14144985"],"URL":"https:\/\/doi.org\/10.3390\/jcm14144985","relation":{},"ISSN":["2077-0383"],"issn-type":[{"value":"2077-0383","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,7,14]]}}}