Posterior Pericardiotomy in Cardiac Surgery: A Randomized Trial on Postoperative Atrial Fibrillation Prevention in a Yemeni Population

Background: Atrial fibrillation (AF) is a common complication following cardiac surgery, particularly in populations undergoing complex cardiac procedures. This randomized clinical trial aimed to evaluate the effectiveness of posterior pericardiotomy (PP) in preventing postoperative atrial fibrillation (POAF) in a Yemeni cardiac surgical population. Methods: This prospective, single-center, randomized clinical trial conducted in Yemen enrolled 210 patients undergoing open-heart surgery involving coronary artery bypass grafting (CABG), aortic valve replacement, ascending aortic surgery, or a combination of these procedures. Patients were randomized using sealed opaque envelopes into either the PP group (n = 106), in which a posterior left pericardiotomy was performed, or the control group (n = 104), which received standard care without pericardiotomy. Results: A total of 436 patients were screened between January 1, 2022, and June 30, 2024, and 210 were randomized. The median age was 60 years (interquartile range (IQR) 50–65), with 165 males (78.5%) and 45 females (21.5%). The incidence of POAF was significantly lower in the PP group compared to the control group (8.5% vs. 22.1%; p = 0.006). Cardiac tamponade occurred exclusively in the control group (n = 10). The PP group also demonstrated significantly shorter mechanical ventilation time (p < 0.001) and intensive care unit (ICU) stay (p = 0.004). In-hospital mortality was significantly lower in the PP group compared to the control group (p = 0.067). Conclusion: Our findings reinforce the evidence supporting PP as a simple, low-cost adjunct to cardiac surgery. Thus, PP may improve postoperative recovery and resource utilization by reducing POAF, pericardial effusion, and tamponade, particularly in resource-limited settings such as Yemen. Clinical Trial Registration: NCT07266935, https://clinicaltrials.gov/study/NCT07266935.