Why the study?
Postoperative pericardial effusion is common after cardiovascular surgery, but the effectiveness of posterior pericardiotomy in reducing pericardial effusion and postoperative atrial fibrillation after thoracic aortic surgery required evaluation.
Does posterior pericardiotomy reduce postoperative atrial fibrillation and pericardial effusion in patients undergoing thoracic aortic surgery?
Does posterior pericardiotomy reduce postoperative atrial fibrillation and pericardial effusion in patients undergoing thoracic aortic surgery?
Posterior pericardiotomy during thoracic aortic surgery does not prevent postoperative atrial fibrillation but safely reduces late pericardial tamponade, mechanical ventilation time, and hospital stay.
Posterior pericardiotomy should not yet alter POAF prevention strategies after aortic surgery; leaves open its potential to reduce tamponade pending randomized confirmation.
BACKGROUND: Postoperative pericardial effusion is common after cardiovascular surgery. We aimed to examine the effectiveness of posterior pericardiotomy in reducing the incidence of postoperative pericardial effusion and postoperative atrial fibrillation after thoracic aortic surgery. METHODS: This study included 201 patients who underwent thoracic aortic open surgery between January 2014 and November 2021. We compared surgical outcomes between patients who underwent posterior pericardiotomy and those who did not. RESULTS: The group that did not undergo posterior pericardiotomy had significantly longer mechanical ventilation duration than the group who did, both in the overall (p = 0.005) and in the propensity-matched cohorts (p = 0.001). The lengths of intensive care unit and hospital stays were significantly longer in the group that did not undergo posterior pericardiotomy compared to the group that did, both in the overall and in the propensity-matched cohorts. The occurrence of postoperative atrial fibrillation and stroke did not differ significantly between the two groups. The amount of pericardial drainage was not significantly lower in the group that underwent posterior pericardiotomy in the overall cohorts (p = 0.09), but the difference was significant in the propensity-matched cohorts (p = 0.04). The amount of mediastinal drainage was significantly lower in the group that underwent posterior pericardiotomy, both in the overall cohorts (< 0.001) and in the propensity-matched cohort (< 0.001). Late pericardial tamponade occurred significantly more frequently in the group that did not undergo posterior pericardiotomy than in the group that did, both in the overall (p = 0.03) and in the propensity-matched cohorts (p = 0.03). CONCLUSIONS: Posterior pericardiotomy has no effect on reducing postoperative atrial fibrillation after thoracic aortic surgery. However, posterior pericardiotomy reduced the occurrence of late pericardial tamponade, length of ICU stay, length of hospital stay, and mechanical ventilation duration after surgery.
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Maze et al. (2022) studied this question.
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