HONG KONG—A clinical trial conducted by researchers at the Chinese University of Hong Kong (CUHK) Faculty of Medicine has demonstrated that a novel procedure, balloon pericardiotomy, drastically reduces the recurrence of malignant pericardial effusion in late-stage cancer patients. The technique slashes the recurrence rate to just 12%, an 80% improvement over traditional drainage methods, minimizing the need for repeated hospitalizations and invasive procedures.
The findings, published today, Oct. 21, in the European Heart Journal, mark a significant advance in palliative care for cancer patients dealing with this life-threatening complication.
Malignant pericardial effusion, the buildup of fluid around the heart caused by tumor growth, can lead to cardiac tamponade, a condition where pressure prevents the heart from filling properly. Traditionally, treatment involves pericardiocentesis, a needle drainage procedure. While effective initially, this method has a high failure rate, with recurrence often exceeding 60%, severely diminishing the quality of life for those already battling advanced disease.
Improving Patient Outcomes and Reducing Hospital Stays
Professor Lin Chen, the Yeung Family Foundation Professor of Oncology at CUHK’s Department of Clinical Oncology, highlighted the critical need for a better solution.
“We estimate that 100 to 150 late-stage cancer patients in Hong Kong undergo drainage for malignant pericardial effusion annually,” Professor Chen noted. “The high recurrence rate forces these patients to return to the hospital repeatedly for needle aspirations, often staying several days at a time. This increases infection risks and profoundly impacts their daily lives.”
The CUHK study, a randomized clinical trial conducted between 2020 and 2024 across four local hospitals, enrolled 50 patients aged 18 or older with malignant tumors and significant pericardial fluid accumulation. Half of the cohort received the balloon pericardiotomy procedure, while the control group received traditional pericardiocentesis.
Within six months, the difference was stark: the recurrence rate for the balloon pericardiotomy group was only 12%, significantly lower than the control group. Furthermore, the risk of developing cardiac tamponade was reduced to just 4%, translating to only one patient in the innovation group experiencing the complication, approximately one-tenth the rate seen in the control group.
A Less-Invasive Alternative to Surgery
Balloon pericardiotomy involves inserting a catheter with a balloon into the pericardial sac. The balloon is then inflated, creating a small window in the pericardium, which allows fluid to drain permanently into adjacent tissues for natural absorption.
Assistant Professor Kwong-ming Tam of the Department of Medicine and Therapeutics stated that while other studies have suggested the feasibility of the procedure, this trial provides the first robust, randomized evidence confirming its superiority over needle drainage in preventing recurrence.
For years, the most durable treatment for effusions involved complex cardiothoracic surgery, such as pericardial window creation, which requires general anesthesia, extended hospital stays, and chest tube placement. Dr. Hung-leung Wong, Chief of Cardiothoracic Surgery at CUHK’s Department of Surgery, emphasized the benefits of the new technique.
“The percutaneous balloon pericardiotomy offers a minimally invasive approach that significantly shortens hospital stays, substantially improving the overall quality of life for these individuals,” Dr. Wong said.
Hope for Late-Stage Patients
One patient, a woman identified only as Ms. Lai, shared her experience after being diagnosed with stage 4 lung cancer and severe effusion in 2020. Constantly short of breath and frequenting the emergency room, she underwent the balloon procedure.
“My recovery was excellent,” Ms. Lai reported. “Not only did the fluid not come back, but I felt physically lighter and much more energized. I haven’t had trouble breathing since the operation.”
While the initial results are promising, Dr. Ping-yin Yan, the study’s principal investigator and Yeung Family Foundation Professor of Cardiology, emphasized that the technique is still in its research phase within Hong Kong’s public hospitals.
The CUHK team plans to expand clinical research and is seeking international collaborations—including trials in Taiwan, Spain, and Thailand—to train more physicians and identify patients who would most benefit from balloon pericardiotomy, solidifying its place as a standard-of-care intervention globally.
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