What is the clinical evidence from this study?

Study design: Meta-Analysis. Population: Cardiac surgery (n=3531). Intervention: Posterior pericardiotomy vs. No intervention. Primary outcome: Incidence of postoperative atrial fibrillation (POAF) (OR 0.45, 95% CI 0.32-0.64, p=<0.0001).

December 23, 2022Open Access

Effect of posterior pericardiotomy in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials

Q: What are the key findings of this study?

Posterior pericardiotomy significantly reduced the incidence of postoperative atrial fibrillation compared to no intervention in patients undergoing cardiac surgery (OR 0.45).

Key Result

Posterior pericardiotomy significantly reduced the incidence of postoperative atrial fibrillation compared to no intervention in patients undergoing cardiac surgery (OR 0.45).

Study Design

Type

Meta-Analysis (n=3,531)

Structured PICO

Does posterior pericardiotomy reduce the incidence of postoperative atrial fibrillation in patients undergoing cardiac surgery?

Population

3,531 adult patients undergoing open heart surgery across 18 randomized controlled trials.

Intervention

Posterior pericardiotomy

Comparator

No intervention

Outcome

Incidence of postoperative atrial fibrillation (POAF)hard clinical

Posterior pericardiotomy during cardiac surgery significantly reduces the incidence of postoperative atrial fibrillation, pericardial effusion, and cardiac tamponade, though it is associated with an increased risk of pleural effusion.

Main Result

Odds Ratio: 0.45 (95% CI 0.32–0.64)

p-value: p=<0.0001

Limitations

Cannot control for individual biases of the included studies
Variability in POAF detection methods, perioperative management, PP technique, and in the definition and reporting of outcomes of interest
Clinical outcomes of relevance to POAF like stroke and transient ischemic attack (TIA) were not reported in most studies

Abstract

Background Posterior pericardiotomy (PP) has been shown to reduce the incidence of pericardial effusion and postoperative atrial fibrillation (POAF) after cardiac surgery. However, the procedure and the totality of its effects are poorly known in the cardiac surgery community. We performed a study-level meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of PP in cardiac surgery patients. Methods A systematic literature search was conducted on three medical databases (Ovid MEDLINE, Ovid Embase, Cochrane Library) to identify RCTs reporting outcomes of patients that received a PP or no intervention after cardiac surgery. The primary outcome was the incidence of POAF. Key secondary outcomes were operative mortality, incidence of pericardial and pleural effusion, cardiac tamponade, length of stay (LOS), pulmonary complications, amount of chest drainage, need for intra-aortic balloon pump, and re-exploration for bleeding. Results Eighteen RCTs totaling 3, 531 patients were included. PP was associated with a significantly lower incidence of POAF (odds ratio OR 0. 45, 95% confidence interval CI 0. 32–0. 64, P 0. 0001), early (OR 0. 18, 95% CI 0. 10–0. 34, P 0. 0001) and late pericardial effusion (incidence rate ratio 0. 13, 95% CI 0. 06–0. 29, P 0. 0001), and cardiac tamponade (risk difference −0. 02, 95% CI −0. 04 to −0. 01, P = 0. 001). PP was associated with a higher incidence of pleural effusion (OR 1. 42, 95% CI 1. 06–1. 90, P = 0. 02), but not pulmonary complications (OR 0. 82, 95% CI 0. 56–1. 19; P = 0. 38). No differences in other outcomes, including operative mortality, were found. Conclusions PP is a safe and effective intervention that significantly decreases the incidence of POAF and pericardial effusion following cardiac surgery. Systematic review registration https: //www. crd. york. ac. uk/prospero/displayᵣecord. php? RecordID=261485, identifier: CRD42021261485.

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