Why the study?
Does routine pericardial closure affect acute hemodynamics in patients undergoing cardiac surgery?
Does routine pericardial closure affect acute hemodynamics in patients undergoing cardiac surgery?
Routine pericardial closure after cardiac surgery causes a mild, reversible decrease in cardiac output and ventricular filling, though it remains clinically well tolerated.
May warrant selective non-closure to preserve output in marginal patients; leaves open effects on clinical outcomes.
Acute hemodynamic effects of a routine pericardial closure after cardiopulmonary bypass was studied in 29 patients undergoing cardiac surgery. Clinically, the pericardial closure was well tolerated. Pericardial closure resulted in an 8% decrease of cardiac output (p less than 0.01) while cardiac index remained normal (2.9 l/min/m2 +/- 0.6 SD). The effect of the pericardium on pulmonary arterial and wedge pressures, and on systemic arterial pressure was not significant. Central venous pressure increased from 8 +/- 2 mmHg to 9 +/- 3 mmHg (p less than 0.05) after pericardial closure and decreased to 7 +/- 3 mmHg (p less than 0.05) when the pericardium was reopened. Left ventricular end-diastolic cavity diameter by echocardiography decreased in 19 of the patients studied from 46 +/- 6 mm to 41 +/- 5 mm (p less than 0.01) when the pericardium was closed, and increased to 45 +/- 6 mm (p less than 0.01) after re-opening of the pericardiotomy incision. The hemodynamic effects of pericardial closure seem to result from limited ventricular filling.
No takes yet. Share an insight, caveat, or question.
Järvinen et al. (1987) studied this question.
Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context: