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Posterior left pericardiotomy: what is the advantage in cardiac surgery?
Antonino Di Franco1, Sigrid Sandner2, Giovanni Jr Soletti1
1Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, USA.
Insights
Posterior pericardiotomy (PP) may reduce postoperative atrial fibrillation (POAF) after cardiac surgery. This simple technique shows promise for improving patient outcomes, though further multicenter trials are needed for definitive conclusions.
Area of Science:
- Cardiac Surgery
- Thoracic Surgery
- Cardiology
Background:
- Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery.
- POAF increases hospital stay, costs, morbidity (stroke, heart failure), and mortality.
- Posterior pericardiotomy (PP) is a technique to drain the pericardium into the left pleural cavity to prevent POAF.
Purpose of the Study:
- To review current evidence on the efficacy of posterior pericardiotomy (PP) in reducing POAF.
- To highlight future research directions for PP in cardiac surgery.
Main Methods:
- Narrative review based on collegial selection of relevant literature.
- No systematic literature search was performed.
Main Results:
- Studies suggest PP decreases the incidence of POAF, pericardial effusion, and cardiac tamponade post-cardiac surgery.
- Increased pleural effusion incidence after PP did not correlate with increased pulmonary complications.
- Long-term outcome improvement with routine PP remains uncertain.
Conclusions:
- Posterior pericardiotomy is a safe and simple procedure with potential benefits for cardiac surgery patients.
- Upcoming multicenter trials are expected to provide definitive evidence on the role of PP.
Objectives:
Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery and is associated with prolonged in-hospital stay and increased costs, morbidity (including stroke and heart failure) and mortality. Posterior pericardiotomy (PP) is a surgical intervention aimed at draining the pericardium into the left pleural cavity to reduce POAF occurrence. This review summarizes the current evidence on the use of PP and highlights future perspectives for clinical research.
Methods:
The present work is a narrative review, a systematic literature search was therefore not performed. After collegial discussion, the most relevant papers as per the authors' opinion were selected and formed the basis of the present review.
Results:
Several studies support the hypothesis that PP decreases the incidence of POAF, pericardial effusion and cardiac tamponade after cardiac surgery. Although an increased incidence of pleural effusion has been reported after PP, this finding does not translate into increased pulmonary complications. Whether the systematic use of PP during cardiac surgery improves long-term outcomes is unclear.
Conclusions:
PP is a simple and safe technique that holds the potential to positively impact cardiac surgical patients' postoperative course. The results of upcoming, multicentre trials will help shed definitive light on this topic.
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