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Surgical Approach for Pericardial Fenestration Name Change Proposal from Subxiphoid to Substernal

Various surgical approaches for pericardial fenestration are described in the medical literature and are used in practice. Each of them has its advantages and disadvantages depending on the cause suggesting the need of pericardial fenestration. The purpose of this study is to demonstrate whether the substernal approach after resection of the xiphoid process is a safe and effective approach to the surgical treatment of pericardial tamponade. From 2000 to 2017 in the Clinic of Thoracic Surgery at the University Hospital “Prof. Dr. St. Kirkovich” – Trakia University, Stara Zagora, Bulgaria, and in the Clinic of Thoracic Surgery at the University Hospital for Active Treatment of Pulmonary Diseases “St. Sophia”, Faculty of Medicine, Medical University – Sofia, Bulgaria, a total of seventy-one patients were diagnosed with pericardial effusion, respectively pericardial tamponade, and due to this underwent surgery. In thirty-two of them, the pericardial effusion was accompanied by a malignant pleural effusion (MPE). The VATS – Fenestratio pericardii procedure was performed on 29 patients while substernal pericardial fenestration was performed on the remaining 42 patients. Operative and perioperative mortality was not reported. Operative complications such as bleeding, damage to the coronary artery or myocardium did not occur. The average operating time was 38 min and the average length of hospital stay was 5 days. After resection and removal of the xiphoid process, the surgeon has sufficient and comfortable working space. The substernal approach after resection of the xiphoid process is a safe and effective approach to the surgical treatment of pericardial tamponade.