Posterior pericardiotomy reduces postoperative AF and pericardial effusion risk after cardiac surgery

Posterior pericardiotomy (PP) is a safe and effective technique that reduces the risk of postoperative atrial fibrillation (POAF) and pericardial effusion after cardiac surgery, suggests an article published in Frontiers in Cardiovascular Medicine. 

Despite advancements in postoperative care, postoperative atrial fibrillation remains the most common complication of cardiac surgery, resulting in a significant clinical and economic burden. The buildup of fluid in the posterior pericardium appears to be a key trigger of POAF, among other things. After cardiac surgery, posterior pericardiotomy (PP) has been proven to lower the frequency of pericardial effusion and postoperative atrial fibrillation (POAF). Unfortunately, the operation and its overall consequences are little understood in the cardiac surgery field. As a result, Giovanni Junior Soletti and colleagues conducted a study-level meta-analysis of the randomized controlled trials (RCTs) to assess the efficacy of PP in cardiac surgery patients.

To locate RCTs reporting outcomes of patients who received a PP or no intervention following cardiac surgery, a comprehensive literature search was undertaken on three medical databases (Ovid Embase, Ovid MEDLINE, and Cochrane Library). The incidence of POAF was the main outcome. The following secondary outcomes were important: surgical mortality, cardiac tamponade, pericardial and pleural effusion, pulmonary complications, length of stay (LOS), volume of chest drainage, requirement for intra-aortic balloon pump, and bleeding re-exploration.

The key findings of this study were:

Eighteen randomized controlled trials with a total of 3,531 subjects were included. 

POAF, early and late pericardial effusion, and cardiac tamponade were all considerably reduced in people who took PP. 

PP was linked to an increased risk of pleural effusion but not pulmonary consequences. 

There were no changes in other outcomes, including operational mortality.

In conclusion, PP is related with a decreased incidence of pericardial effusion, POAF, and cardiac tamponade, but an increased risk of pleural effusion, according to a meta-analysis of 18 studies.

Reference: 

Soletti, G. J., Perezgrovas-Olaria, R., Harik, L., Rahouma, M., Dimagli, A., Alzghari, T., Demetres, M., Bratton, B. A., Yaghmour, M., Satija, D., Lau, C., Girardi, L. N., Salemo, T. A., & Gaudino, M. (2022). Effect of posterior pericardiotomy in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. In Frontiers in Cardiovascular Medicine (Vol. 9). Frontiers Media SA. https://doi.org/10.3389/fcvm.2022.1090102