Should the pericardium be closed routinely after heart operations?

Area of Science:

• Cardiovascular Surgery
• Cardiac Anatomy
• Surgical Techniques

Background:

• Repeat coronary artery bypass grafting (CABG) presents challenges due to potential right ventricular adhesions to the sternum.
• Pericardial closure during initial CABG may prevent these adhesions, simplifying re-operation.
• The geometric impact of pericardial closure post-CABG requires investigation.

Purpose of the Study:

• To evaluate the geometric effects of pericardial closure after isolated coronary artery bypass grafting (CABG).
• To assess the impact of pericardial closure on right ventricular-sternal distance and early postoperative hemodynamics.

Main Methods:

• Randomized controlled trial involving 42 patients undergoing elective, isolated CABG.
• Patients were assigned to either pericardial closure (n=20) or open pericardium (n=22) groups.
• Radiopaque markers on the right ventricle tracked epicardial-sternal distances postoperatively.

Main Results:

• Pericardial closure significantly increased the distance between the right ventricle epicardium and sternum at 1 week and 3 months (p < 0.001).
• The closure group exhibited lower early postoperative cardiac index and stroke work index despite similar filling pressures (p < 0.001).

Conclusions:

• Pericardial closure may mitigate myocardial injury risk in repeat CABG by preventing right ventricular adhesions.
• Adverse early hemodynamic effects suggest caution with pericardial closure in patients with impaired ventricular function.