The Effect of Posterior Pericardiotomy on Postoperative Pericardial Effusion in Coronary Artery Bypass Surgery

Abstract

Background: Pericardial effusion is commonly seen after coronary artery bypass surgery; large pericardial effusion develops at 4 to 10 days postoperatively in 30% of patients undergoing cardiac surgery. However, regional pericardial effusions are often localized posteriorly; one of the recent solutions to reduce this complication is posterior pericardiotomy, which also significantly reduces late pericardial effusion and late posterior tamponade. Aim: our target is to assess the impact and effectiveness of posterior pericardiotomy in reducing post-cardiac surgery pericardial effusion and tamponade. Patients and Methods: This prospective randomized case-controlled study was carried out in 64 patients. They were randomly assigned to one of 2 groups of 32 patients each. Longitudinal incision in the pericardium was made parallel and posterior to the left phrenic nerve in group one and not in group II, then we evaluated the results between the two groups as regards post operative pericardial effusion. Results: There were no statistically significant differences between the groups with respect to demographic or operative characteristics. The pericardiotomy group had lower incidence of postoperative pericardial effusion as 68.75% of the Pericardiotomy group had no effusion in the first seven days, while it was 43.3% in the control group, and none of the Pericardiotomy group developed severe pericardial effusion at any time. Conclusion: posterior pericardiotomy significantly reduce postoperative effusion and tamponade, and we recommend it in all the cases of cardiac surgery operations.

Influence of Posterior Pericardiotomy on Early and Late Pericardial Effusions Post CABG

“…In contrary, many other studies showed that PP intervention did not affect ventilation time, ICU stay, and hospital stay (15)(16)(17)23,28) . There was no significant difference in ventilation time, ICU stay, and hospital stay between the two treatment groups.…”

“…Also, it protected against delayed tamponade events. Thus, Amr et al (28) detected that the incidence of these events, including early and late PE , developed about 54% and 21% among patients without intervention respectively. Also, the incidence of delayed tamponade may totally disappear in intervention group (0%) vs. (10%) in control group.…”