Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial

Gaudino, Mario; Sanna, Tommaso; Ballman, Karla V.; Robinson, N. Bryce; Hameed, Irbaz; Audisio, Katia; Rahouma, Mohamed; Franco, Antonino Di; Soletti, Giovanni; Lau, Christopher; Rong, Lisa Q.; Massetti, Massimo; Gillinov, Marc; Ad, Niv; Voisine, Pierre; DiMaio, J. Michael; Chikwe, Joanna; Fremes, Stephen E.; Crea, Filippo; Puskas, John D.; Girardi, Leonard N.

doi:10.1016/s0140-6736(21)02490-9

Cited by 87 publications

(67 citation statements)

References 20 publications

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“…Although POAF has been considered temporary and rather harmless, there was even an association with long-term mortality, stroke, and long-standing persistent atrial fibrillation. 20 Although a causal relationship between POAF and adverse events has not been established, the following randomized controlled trial 21 is important in this context because it shows an effective way to reduce POAF without increasing the risk of postoperative complications. The authors randomly assigned 420 adult patients without pre-existing atrial fibrillation to undergo posterior left pericardiotomy or no intervention during elective cardiac surgery.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 99%

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Cardiac Surgery 2021 Reviewed

Doenst

Schneider

Can

et al. 2022

Thorac Cardiovasc Surg

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PubMed displayed more than 35,000 hits for the search term “cardiac surgery AND 2021.” We used the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-analyses) approach and selected relevant publications for a results-oriented summary. As in recent years, we reviewed the fields of coronary and conventional valve surgery and their overlap with their interventional alternatives. COVID reduced cardiac surgical activity around the world. In the coronary field, the FAME 3 trial dominated publications by practically repeating SYNTAX, but with modern stents and fractional flow reserve (FFR)-guided percutaneous coronary interventions (PCIs). PCI was again unable to achieve non-inferiority compared with coronary artery bypass graft surgery (CABG) in patients with triple-vessel disease. Survival advantages of CABG over PCI could be linked to a reduction in myocardial infarctions and current terminology was criticized because the term “myocardial revascularization” is not precise and does not reflect the infarct-preventing collateralization effect of CABG. In structural heart disease, new guidelines were published, providing upgrades of interventional treatments of both aortic and mitral valve disease. While for aortic stenosis, transcatheter aortic valve implantation (TAVI) received a primary recommendation in older and high-risk patients; recommendations for transcatheter mitral edge-to-edge treatment were upgraded for patients considered inappropriate for surgery. For heart team discussions it is important to know that classic aortic valve replacement currently provides strong signals (from registry and randomized evidence) for a survival advantage over TAVI after 5 years. This article summarizes publications perceived as important by us. It can neither be complete nor free of individual interpretation, but provides up-to-date information for decision-making and patient information.

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Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 99%

“…4A ). 21 The next trial will have to test the impact of reducing long-term adverse events through reducing POAF.…”

Section: Surgical Treatment Of Coronary Artery Diseasementioning

confidence: 99%

Cardiac Surgery 2021 Reviewed

Doenst

Schneider

Can

et al. 2022

Thorac Cardiovasc Surg

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“…[8] demonstrated a reduction in both pericardial effusion and related supraventricular arrhythmias with PP. Since then, there have been con icting reports on the e cacy of PP for POAF [7][8][9][10][11][12][13][22][23][24]. PP provides an effective pathway for drainage of pericardial effusion, which has the abovementioned in ammatory-inducing components, to the pleural cavity.…”

Section: Mulay Et Almentioning

confidence: 99%

“…Therefore, prevention of POAF is important. Previous studies have reported that posterior pericardiotomy (PP) reduces POAF [8,9], and more recent reports have reviewed the POAF-reducing effect of posterior pericardial drainage or PP [10][11][12][13]. However, although there have been cohort studies examining the POAF-reducing effects of pericardial drainage or PP after CABG or AVR or after CABG, AVR, and thoracic aortic surgery, these effects have not been evaluated after thoracic aortic surgery alone.…”

Section: Introductionmentioning

confidence: 99%

The effect of posterior pericardiotomy after thoracic aortic surgery

Maze

Tokui

Murakami

et al. 2022

Preprint

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BackgroundPostoperative atrial fibrillation is a common complication of cardiovascular surgery. We aimed to examine the effectiveness of posterior pericardiotomy in reducing the incidence of postoperative atrial fibrillation after thoracic aortic surgery.MethodsThe study included 201 patients who underwent thoracic aortic open surgery between January 2014 and November 2021. We compared surgical outcomes between patients who underwent posterior pericardiotomy and those who did not. We also compared the preoperative characteristics and surgical outcomes between patients who showed postoperative atrial fibrillation and those who did not. Multivariate analysis was performed to determine the risk factors for postoperative atrial fibrillation.ResultsThe group that did not undergo posterior pericardiotomy had significantly longer mechanical ventilation duration than the group who did in the overall (p=0.005) and propensity-matched cohorts (p=0.001). The lengths of intensive care unit and hospital stays were significantly longer in the group that did not undergo posterior pericardiotomy than in the group that did in the overall and propensity-matched cohorts. Postoperative atrial fibrillation occurrence did not differ significantly between the two groups. Late pericardial tamponade occurred significantly more frequently in the group that did not undergo posterior pericardiotomy than in the group that did in the overall (p=0.03) and propensity-matched cohorts (p=0.03). Advanced age was independent predictors of postoperative atrial fibrillation. ConclusionsPosterior pericardiotomy has no effect on reducing postoperative atrial fibrillation after thoracic aortic surgery. Posterior pericardiotomy reduced the occurrence of late pericardial tamponade, length of ICU stay, length of hospital stay, and mechanical ventilation duration after surgery.

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“…In a recent single-center, randomized, adaptive clinical trial, researchers demonstrated that posterior left pericardiotomy, a simple surgical procedure, decreases the incidence of postoperative atrial fibrillation in certain types of cardiac surgery involving the coronary arteries, aortic valve, ascending aorta, or a combination of these. 56 The authors hypothesized that posterior left pericardiotomy, a procedure that involves a 4–5 cm vertical incision into the pericardial space to allow drainage of pericardial fluid into the left pleural cavity at the time of cardiac surgery would decrease the incidence of post-operative atrial fibrillation . The primary outcome was occurrence of post-operative atrial fibrillation as assessed by continuous 12 lead EKG monitoring.…”

Section: Introductionmentioning

confidence: 99%

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

Smoroda

Douin

Morabito

et al. 2022

Semin Cardiothorac Vasc Anesth

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In 2021, progress in clinical science related to Cardiac Anesthesiology continued, but at a slower rate due to the ongoing pandemic and disruptions to clinical research. Most progress was incremental and addressed persistent questions related to our field. To identify articles for this review, we completed a structured review using our previously reported methods (1). Specifically, we used the search terms: “cardiac anesthesiology and outcomes” (n = 177), “cardiothoracic anesthesiology” (n = 34), “cardiac anesthesia,” and “clinical outcomes” (n = 42) filtered on clinical trials and the year 2021 in PubMed. We also reviewed clinical trials from the most prominent clinical journals to identify additional studies for a narrative review. We then selected the most noteworthy publications for inclusion in this review and identified key themes.

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Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: an adaptive, single-centre, single-blind, randomised, controlled trial

Cited by 87 publications

References 20 publications

Cardiac Surgery 2021 Reviewed

Cardiac Surgery 2021 Reviewed

The effect of posterior pericardiotomy after thoracic aortic surgery

Year in Review 2021: Noteworthy Literature in Cardiothoracic Anesthesia

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