Pericardiotomy and atrial fibrillation after isolated coronary artery bypass grafting: A systematic review and meta-analysis of 16 randomised controlled trials

Taw Moe Myat San; Khin Phue Phue Han; Muhammad Ismail; Lei Myint Thu; Myat Soe Thet

doi:10.1016/j.carrev.2024.03.023

March 30, 2024Cardiovascular revascularization medicineOpen Access

Pericardiotomy and atrial fibrillation after isolated coronary artery bypass grafting: A systematic review and meta-analysis of 16 randomised controlled trials

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Why the study?

AF and pericardial effusion are notable complications following CABG that increase morbidity and healthcare costs, and posterior pericardiotomy has been proposed to mitigate them.

Does prophylactic posterior pericardiotomy reduce postoperative atrial fibrillation and pericardial effusion in adult patients undergoing isolated CABG?

Structured PICO

Does prophylactic posterior pericardiotomy reduce postoperative atrial fibrillation and pericardial effusion in adult patients undergoing isolated CABG?

P

Population

16 RCTs pooling 2,414 adult patients undergoing isolated coronary artery bypass grafting (CABG)

I

Intervention

Prophylactic posterior pericardiotomy

C

Comparator

Control treatments (standard care without posterior pericardiotomy)

O

Outcome

Incidences of postoperative atrial fibrillation and pericardial effusionhard clinical

Prophylactic posterior pericardiotomy during isolated CABG significantly reduces the risk of postoperative atrial fibrillation and pericardial effusion, though evidence is limited by heterogeneity and publication bias.

Limitations

Substantial heterogeneity
Publication bias

Implication

Posterior pericardiotomy may reduce postoperative AF and effusion after CABG; leaves open need for larger trials before practice change.

Abstract

BACKGROUND: Atrial fibrillation (AF) and pericardial effusion are notable complications following coronary artery bypass grafting (CABG), contributing to increased morbidity and healthcare costs. Posterior pericardiotomy has been proposed to mitigate these complications. This systematic review and meta-analysis aim to evaluate the efficacy of posterior pericardiotomy in reducing postoperative AF and pericardial effusion in isolated CABG patients. MATERIALS AND METHODS: A comprehensive literature search, adhering to PRISMA guidelines, was conducted across PubMed, MEDLINE via Ovid, Embase, Scopus, the Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov up to December 2023. Only randomised controlled trials (RCTs) comparing prophylactic posterior pericardiotomy to control treatments in adult CABG patients were included. The primary outcomes assessed were the incidences of postoperative AF and pericardial effusion. RESULTS: The meta-analysis incorporated 16 RCTs with a total of 2414 patients. The findings demonstrated a significant reduction in the incidence of postoperative AF (Odds Ratio = 0.34, 95 % CI: 0.25-0.48, P < 0.00001) and pericardial effusion (Odd Ratio = 0.24, 95 % CI: 0.15-0.38, P < 0.0001) in the group undergoing posterior pericardiotomy. However, the analysis revealed substantial heterogeneity and publication bias in the included studies. CONCLUSION: The posterior pericardiotomy is effective in reducing the incidences of AF and pericardial effusion in patients undergoing isolated CABG. Despite the positive outcomes, the presence of heterogeneity and publication bias warrants a cautious interpretation of the results and underscores the need for further multicentre RCTs in this area.