Pericardiostomy is a surgical procedure in which the pericardium (the membranous sac surrounding the heart) is incised and a drainage tube is inserted to allow continuous or intermittent drainage of fluid from the pericardial space. It is used when a significant accumulation of fluid (pericardial effusion) is causing symptoms or haemodynamic compromise, and when repeated needle drainage (pericardiocentesis) has failed or is expected to be insufficient.
The most common indication is a large, recurrent, or infected pericardial effusion. Septic pericarditis caused by bacterial or fungal infection typically requires a surgical pericardiostomy rather than simple needle drainage because the fluid is thick, pus-like, and loculated (compartmentalised), making complete needle drainage impossible. Malignant pericardial effusions from cancer extending to the pericardium also commonly recur after needle drainage and may be managed with pericardiostomy to provide ongoing drainage.
Pericardiostomy may be performed via a subxiphoid incision (a small cut below the sternum) or via a thoracoscopic (keyhole) approach, depending on the patient’s condition and the surgeon’s preference. A drain is left in place until daily drainage falls below a specified volume, at which point it is removed. The procedure can often be performed under local anaesthesia and sedation in patients who are too unwell for a general anaesthetic.
Pericardiostomy should be distinguished from pericardiectomy (complete or partial removal of the pericardium), which is a larger operation performed specifically for constrictive pericarditis where scarred pericardium must be excised rather than simply drained.
« Back to Glossary Index