Fluoroscopic Pericardiocentesis by Cardiac Surgeons: Hybrid Setup Outcomes

Abstract Pericardiocentesis is a life-saving intervention in the treatment of cardiac tamponade. This study aims to evaluate the safety, efficacy, and short-term outcomes of fluoroscopy-guided pericardiocentesis performed by cardiovascular surgeons in a hybrid operating room setting. Data from 64 patients who underwent fluoroscopy-guided percutaneous drainage for symptomatic pericardial effusion in a hybrid operating room between January 2020 and December 2024 were analyzed retrospectively. Procedures were performed using a standard subxiphoid approach and a pigtail catheter. The etiology was malignancy in 31.2% (n = 20) of the patients. The median maximum effusion diameter measured on preoperative echocardiography was 24 mm (interquartile range [IQR]: 20–28 mm), which decreased significantly to 7 mm (IQR: 5–9 mm) on postoperative evaluation (p < 0.001). The minor complication rate was 1.5% (n = 1, pneumothorax). No surgical conversion (sternotomy) was required during the procedures. Reintervention was required in only two patients (3.1%) during the 3-month follow-up. Fluoroscopy-guided pericardiocentesis performed under hybrid operating room conditions represents a safe option with low complication and recurrence rates, even in high-risk groups such as malignancy. The real-time anatomical visualization provided by fluoroscopy, combined with the surgical infrastructure of the hybrid environment, provides a feasible workflow for cardiac surgeons. However, these findings need to be supported by more extensive and comparative studies.