Background: This study aims to compare the outcomes of the two most common surgical techniques applied in patients with symptomatic pericardial effusion following open heart surgery. Methods: Between September 2004 and September 2012, we retrospectively analyzed the data of 14,390 patients who underwent open heart surgery in our clinic. A total of 152 patients were included and divided into two groups, according to treatment modality applied. Subxiphoid pericardial drainage was performed in 86 patients (56.6%) (group 1) and pericardial window opening via lateral thoracotomy was performed in 66 patients (43.4%) (group 2). We further analyzed the patients who underwent surgical reexploration due to symptomatic pericardial effusion via lateral thoracotomy or subxiphoid procedure. Perioperative outcomes were compared in terms of operative and 30-day in-hospital mortality. Results: In group 2, operative technique produced a complete success (100%), whereas the success rate was 87.2% in group 1 (p<0.003). Local anesthesia was preferred in 73 patients (84.9%) in group 1 and shorter operation times were observed (p<0.001). Although four patients (4.7%) died in the operating room in group 1, there was no statistically significant difference in operative mortality between the groups (p=0.133). Technical failure in group 1 led to increased mortality rates (36.4%) (p<0001). Conclusion: Although subxiphoid procedure can be performed rapidly with ease, technical failure is not rare and may be associated with high mortality rates.