Posterior left pericardiotomy for prevention of re-thoracotomy and postoperative atrial fibrillation in aortic surgery

OBJECTIVES: Re-thoracotomy due to pericardial effusion is a frequent complication after aortic surgery, leading to prolonged intensive care unit (ICU) and hospital stays and adverse outcomes. This study aims to evaluate the frequency of re-thoracotomy and postoperative atrial fibrillation in patients undergoing ascending aorta replacement with or without posterior left pericardiotomy. METHODS: We retrospectively analysed clinical data from patients who underwent elective ascending aorta replacement with or without aortic root between January 2014 and June 2024. Patients were divided into two groups based on posterior left pericardiotomy. We assessed re-thoracotomy due to bleeding or pericardial effusion, postoperative atrial fibrillation, ICU and in-hospital stay, as well as mortality rates, adjusting for confounders using propensity score matching. RESULTS: A total of 256 patients could be included (n = 140 without and n = 116 with posterior left pericardiotomy). Mean age was 61.6 ±12.2 years, with 27.7% female patients. After matching, re-thoracotomy (12.9% vs 3.4%; P = 0.007) and postoperative atrial fibrillation (36.4% vs 16.4%; P = 0.011) were higher in patients without pericardiotomy. Thirty-day and 1-year mortality were 1.3% and 4.2%, respectively. Posterior left pericardiotomy was associated with shorter ventilation time (8.0 vs 15.0 hours; P < 0.001) and hospital stay (8.0 vs 12.0 days; P < 0.001). Similar results were observed between the unmatched and the matched cohort. CONCLUSIONS: Posterior left pericardiotomy is a simple surgical manoeuvre associated with lower rates of re-thoracotomy and postoperative atrial fibrillation in elective aortic surgery patients in a retrospective cohort. Further prospective randomized trials should be performed to confirm and highlight the results from our study.