Can posterior pericardiotomy reduce the incidence of postoperative atrial fibrillation after coronary artery bypass grafting?

Abstract

Posterior pericardiotomy is a simple, safe and effective method for reducing the incidence of postoperative pericardial effusion and related atrial fibrillation by improving pericardial drainage after coronary artery bypass grafting.

Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery

“…Of those, 18 were further excluded because they were not pertinent to the design of the meta-analysis or did not meet the explicit inclusion criteria. Nineteen RCTs 11,[19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36][37] that enrolled 3425 patients eventually were included in the analysis. Patients were divided into 2 groups: those with a posterior pericardial drainage (n ¼ 1723) and control group without (n ¼ 1702).…”

“…In the group of patients who received a posterior pericardial drainage, 1447 patients underwent PP 11,[19][20][21][22][23][24][25][26][28][29][30][33][34][35][36][37] ; in 103 patients, a chest tube was placed within the posterior pericardium 27,30 ; 173 patients received both PP and posterior pericardium chest tube. 31,32 On-pump coronary artery bypass grafting (CABG) was the most frequently performed cardiac procedure, 11,19,20,23,25,28,[30][31][32][33][34][35][36] followed by combined CABG and/or valve replacement. 21,22,24,37 Two studies reported on patients undergoing valve replacement and/or ascending aorta surgery 26,27 and another on patients who received offpump CABG alone.…”

“…PP was performed as described by Mulay and colleagues 38 and comprised a longitudinal, 4-cm long incision parallel and posterior to the phrenic nerve, extending from left inferior pulmonary vein to the diaphragm in most cases. 11,[19][20][21][22][23][24][25][26][28][29][30][31][32]35,36 A detailed technique is reported in Table E5. Table E6 includes an analysis of potential sources of bias for randomized studies using the components recommended by the Cochrane Collaboration.…”

“…A longitudinal, 4-cm long incision parallel and posterior to the phrenic nerve, extending from left inferior pulmonary vein to the diaphragm. Fawzy and colleagues 28 Two drains in both groups, one in the left pleural cavity and the other in the anterior mediastinum. Pericardium left open anteriorly.…”

Efficacy of posterior pericardiotomy in prevention of atrial fibrillation and pericardial effusion after aortic valve replacement: a randomized controlled trial

“…Эффективность ЗП в профилактике ПОФП ранее пока-зана в целом ряде когортных и рандомизированных иссле-дований после коронарного шунтирования [9,[17][18][19][20][21][22]. В то же время в отдельных исследованиях эффективность ЗП показать не удалось [23][24][25], однако результаты метаана-лизов [10,12,13] и кохрейновского обзора [11] подтверж-дают снижение риска ПОФП при задней перикардиото-мии у больных после коронарного шунтирования.…”