The left paraxiphoidian approach is a well-tolerated and effective technique for draining pericardial effusions and obtaining pericardial biopsies without requiring xiphoid resection.
May support pericardial access without xiphoid resection in select cases; leaves open need for prospective validation before practice change.
Pericardial effusion is one of the frequent complications of malignancies, up to 15-20% of the autopsy specimens showing pericardial or cardiac metastasis. Often the pericardial fluid accumulates in large quantities leading to cardiac tamponade, which can be fatal in the absence of appropriate treatment. The authors present another type of pericardial drainage: the approach is paraxiphoidian, not subxiphoidian or with xiphoid resection. Without xiphoid process resection, the surgery is better tolerated by patients (frequently the drainage is made under local anesthesia). In the case of xiphoid preservation, the surgical intervention is easier (no need for hard retraction of this bone). In all the five cases with this access, the postoperative results were very good, with complete evacuation of pericardial effusion. In all the cases, the pericardial biopsy performed under visual control was sufficient for a histological diagnosis and the immunohistochemical tests, if required.
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Motaş et al. (2009) studied this question.
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