CARDIAC SURGERY The effects of posterior pericardiotomy on pericardial effusion, tamponade, and atrial fibrillation after coronary artery surgery

Abstract

IntroductionPericardial effusion and atrial fibrillation occur commonly after coronary artery surgery.Aim of the studyA prospective randomized clinical trial was conducted to evaluate the effects of posterior pericardiotomy on the occurrence of pericardial effusion, tamponade, and atrial fibrillation.Material and methodsThe study group consisted of 96 patients (77 male and 19 female) at a mean age of 58.1 ± 9.8 years. The patients were randomly assigned to one of three study groups: patients undergoing posterior pericardiotomy (group I, n = 30), controls (group II, n = 33), and patients with additional posterior pericardial drainage tubes (28 mm) who did not undergo posterior pericardiotomy (group III, n = 33).ResultsPostoperative hospitalization (p = 0.03; 11.56 ± 10.64) and reoperation due to tamponade (p = 0.019; 12.1%) were significantly higher in group II. Extensive pericardial effusions were detected in one patient on the first postoperative day (group II, n = 1), in one patient on the fifth postoperative day (group III, n = 1), and in one patient on the 30th day after the operation (group III, n = 1). Pericardial effusion exhibited regression in group I on postoperative day 30 (p = 0.028). A higher rate of postoperative atrial fibrillation was noted in group I, but no significant differences were found between the groups with regard to postoperative atrial fibrillation.ConclusionsPatients who did not undergo posterior pericardiotomy or did not receive posterior chest tubes exhibited residual pericardial effusion, required longer hospitalization, and had to be reoperated due to tamponade. Both posterior pericardiotomy and the use of posterior tubes are effective in the early postoperative period.

Posterior Pericardial Window Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

“…Recent studies reported that postoperative pericardial effusion can provoke the development of atrial fibrillation which is the most prevalent arrhythmia in the postoperative period [13,14]. In our study we releaved that new onset postoperative atrial fibrillation was significantly more common in control group (14.5%) than in the PW group (4.5%, P<.05).…”

Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery

“…A number of surgeons do routinely place a posterior pericardial tube (usually soft flexible rubber tube) in addition to an anterior mediastinal tube in the same time avoiding potential risk of PP-related complications. Yet, no consensus exists on the required duration of such drainage 27,30 and its efficacy in preventing particularly delayed cardiac tamponade. In a subgroup analysis stratified by operative technique, we demonstrated that there were no statistically significant differences between the technical approaches to posterior pericardial drainage in regard to the risk of primary endpoint.…”

“…Of those, 18 were further excluded because they were not pertinent to the design of the meta-analysis or did not meet the explicit inclusion criteria. Nineteen RCTs 11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] that enrolled 3425 patients eventually were included in the analysis. Patients were divided into 2 groups: those with a posterior pericardial drainage (n ¼ 1723) and control group without (n ¼ 1702).…”

“…In the group of patients who received a posterior pericardial drainage, 1447 patients underwent PP 11,[19][20][21][22][23][24][25][26][28][29][30][33][34][35][36][37] ; in 103 patients, a chest tube was placed within the posterior pericardium 27,30 ; 173 patients received both PP and posterior pericardium chest tube. 31,32 On-pump coronary artery bypass grafting (CABG) was the most frequently performed cardiac procedure, 11,19,20,23,25,28,[30][31][32][33][34][35][36] followed by combined CABG and/or valve replacement. 21,22,24,37 Two studies reported on patients undergoing valve replacement and/or ascending aorta surgery 26,27 and another on patients who received offpump CABG alone.…”

“…PP was performed as described by Mulay and colleagues 38 and comprised a longitudinal, 4-cm long incision parallel and posterior to the phrenic nerve, extending from left inferior pulmonary vein to the diaphragm in most cases. 11,[19][20][21][22][23][24][25][26][28][29][30][31][32]35,36 A detailed technique is reported in Table E5. Table E6 includes an analysis of potential sources of bias for randomized studies using the components recommended by the Cochrane Collaboration.…”