Retropericardial hematoma: pitfall in beating heart coronary surgery

Beating heart coronary surgery, now an accepted technique of myocardial revascularization, is perceived to have fewer complications than the conventional on-pump approach. However, little attention has been paid to complications that may be specific to the off-pump method. We describe the unusual development of a large retropericardial hematoma following otherwise uneventful beating heart coronary surgery that resulted in global cardiac displacement. This was recognized and investigated promptly, and led ultimately to complete resolution without morbidity with expectant treatment alone. The implication of this observation is discussed along with other reports of perioperative complications following beating heart coronary surgery.