Postoperative pericardial effusion and posterior pericardiotomy, related or not?

Large pericardial effusions after cardiac surgery develop in 30% of patients and reach their maximum size on approximately day 10 postoperatively. Tamponade develops in approximately 1% of patients with large pericardial effusions. Effusion may be prevented by posterior pericardiotomy, but its role and possible adverse consequences are controversial. We sought to further investigate the effectiveness of this technique.

This prospective randomized case-control study was carried out on 410 patients, mean age 68.4 +/- 9.2 years, who underwent coronary artery bypass graft surgery alone or combined with valve surgery during the period between April 2005 and May 2006. A 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve in the pericardiotomy group. Echocardiographic study was performed at the time of discharge and 15 and 30 days after surgery.

After 15 and 30 days postsurgery, respectively, 178 (90.2%) and 192 (97%) of patients from the pericardiotomy group and none from the conventional group were free of effusion (P < .05).

Posterior pericardiotomy is easy to perform and is a safe and effective means to prevent postoperative effusion and its early and delayed adverse consequences.