Prophylactic routine posterior pericardiotomy: Should we perform it in every patient?

During the American Heart Association Scientific Sessions 2021, Dr Mario Gaudino presented the results of the PALACS (Posterior Left pericardiotomy for the prevention of postoperative Atrial fibrillation after Cardiac Surgery) trial, which were simultaneously published in The Lancet.1 This trial attracted attention to posterior pericardiotomy (PP)—an intervention first applied in cardiac surgery a quarter-century ago,2 whose mechanism of action is linked to the elimination of pericardial effusion—a known trigger of atrial fibrillation.