August 14, 2021Open Access

Posterior pericardiotomy to prevent new-onset atrial fibrillation after coronary artery bypass grafting: a systematic review and meta-analysis of 10 randomized controlled trials

Structured PICO

Does posterior pericardiotomy reduce the incidence of new-onset atrial fibrillation in adult patients undergoing coronary artery bypass grafting?

Population

1,829 adult patients (≥18 years old) undergoing coronary artery bypass grafting (CABG) under cardiopulmonary bypass (CPB) pooled from 10 randomized controlled trials.

Intervention

Posterior pericardiotomy (PP) performed at the end of surgery (longitudinal incision parallel and posterior to the phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm, with two chest drains inserted).

Comparator

Conventional treatment (no posterior pericardiotomy).

Outcome

New-onset postoperative atrial fibrillation (POAF) after CABG under cardiopulmonary bypass.hard clinical

Posterior pericardiotomy is a safe and effective surgical technique that significantly reduces the incidence of new-onset atrial fibrillation and pericardial effusion after coronary artery bypass grafting.

Abstract

BACKGROUND: Atrial fibrillation (AF) is associated with adverse events after cardiac surgery. Multiple studies have reported that posterior pericardiotomy (PP) may be effective for preventing AF after coronary artery bypass grafting (CABG), but some conflicting results have been reported and the quality of evidence from previous meta-analyses has been limited. The present study aimed to systematically evaluate the safety and efficacy of PP for preventing AF after CABG in adults. METHODS: We conducted a quantitative meta-analysis of randomized controlled trials (RCTs) published before May 31, 2021. The primary outcome was AF after CABG under cardiopulmonary bypass. Secondary outcomes included early pericardial effusion, late pericardial effusion, pericardial tamponade, pleural effusion, length of hospital stay, length of intensive care unit (ICU) stay, pulmonary complications, intra-aortic balloon pump use, revision surgery for bleeding, and mortality. RESULTS: Ten RCTs with 1829 patients (910 in the PP group and 919 in the control group) were included in the current meta-analysis. The incidence of AF was 10.3% (94/910) in the PP group and 25.7% (236/919) in the control group. A random-effects model indicated that incidence of AF after CABG significantly lower in the PP group than in the control group (risk ratio = 0.45, 95% confidence interval 0.29-0.64, P < 0.0001). PP also effectively reduced the post-CABG occurrence of early pericardial effusion (RR = 0.28, 95% CI 0.15-0.50; P < 0.05), late pericardial effusion (RR = 0.06, 95% CI 0.02-0.16; P < 0.05), and pericardial tamponade (RR = 0.08, 95% CI 0.02-0.33; P < 0.05) as well as the length of ICU stay (weighted mean difference WMD = 0.91,95% CI 0.57-1.24; P < 0.05), while increasing the occurrence pleural effusion (RR = 1.51, 95% CI 1.19-1.92; P < 0.05). No significant differences length of hospital stay (WMD = - 0.45, 95% CI - 2.44 to 1.54, P = 0.66), pulmonary complications (RR = 0.99, 95% CI 0.71-1.39, P = 0.97), revision surgery for bleeding (RR = 0.84, 95% CI 0.43-1.63, P = 0.60), use of IABP (RR = 1, 95% CI 0.61-1.65, P = 1.0), or death (RR = 0.45, 95% CI 0.07-3.03, P = 0.41) were observed between the PP and control groups. CONCLUSIONS: PP may be a safe, effective, and economical method for preventing AF after CABG in adult patients.

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