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Posterior Pericardial Window and a Single Pleural Drain: A Dual Defence Against Post-CABG Pericardial Effusion and
Redoy Ranjan1,2, Stamatis Kapetanakis3, Venkatachalam Chandrasekaran1
1Department of Cardiac Surgery, St George's University Hospitals NHS Foundation Trust, London, UK.
Insights
A posterior pericardial window with a single left pleural drain effectively reduces pericardial effusion and postoperative atrial fibrillation (POAF) after coronary artery bypass graft (CABG) surgery. This minimally invasive approach offers improved outcomes compared to traditional drainage methods.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Postoperative new atrial fibrillation (POAF) is a common complication following coronary artery bypass graft (CABG) surgery.
- POAF is frequently associated with postoperative pericardial effusion.
- Current drainage methods may contribute to complications.
Purpose of the Study:
- To evaluate the effectiveness of a posterior pericardial window (PPW) with a single left pleural drain.
- To assess the reduction of post-CABG pericardial effusion and POAF.
- To compare outcomes without mediastinal chest drains.
Main Methods:
- A descriptive observational study comparing PPW with a single left pleural drain versus routine multiple mediastinal and pleural drains.
- Continuous telemonitoring for 96 hours post-surgery to assess heart rhythm.
- Bedside echocardiography on postoperative day 4 to evaluate pericardial effusion.
Main Results:
- 250 age and sex-adjusted isolated elective on-pump CABG patients were evaluated.
- The PPW group showed significantly lower rates of >1cm pericardial effusions (0.8% vs 14.1%, P <0.001).
- The incidence of POAF was significantly lower in the PPW group (6.9% vs 19.3%, P =0.002).
Conclusions:
- A posterior pericardial window with a single left pleural drain is effective in reducing pericardial effusion post-CABG.
- This technique also significantly lowers the incidence of postoperative atrial fibrillation.
- The PPW approach offers a beneficial alternative to traditional drainage methods.
Background:
Postoperative new atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) and is often associated with postoperative pericardial effusion. We aimed to investigate the effectiveness of a posterior pericardial window (PPW) with a single left pleural drain in reducing post-CABG pericardial effusion and atrial fibrillation without mediastinal chest drains.
Methods:
This descriptive observational study evaluated age and sex-adjusted isolated elective on-pump CABG patients into two groups: PPW with only left pleural chest drains and control (routine multiple mediastinal and pleural chest drains. We performed continuous telemonitoring for 96 hours after surgery to assess heart rhythm, followed by daily electrocardiograms. Bedside echocardiography was conducted on postoperative day 4 to check for pericardial effusion.
Results:
This study evaluated age and sex-adjusted 250 CABG patients, with male predominance (80%) and identical comorbidities between study groups. We found similar age (61.5 ±7.5 vs 62.6 ±6.2, P =0.40) and male sex (86.9% vs 74.8%, P =0.13) between the PPW and control groups. Additionally, the sociodemographic and intraoperative variables were the same across the study groups (P >0.05). The occurrence of >1cm pericardial effusions (0.8% vs 14.1%, P <0.001) and postoperative AF (6.9% vs 19.3%, P =0.002) occurrence was significantly lower in the PPW compared to the control group.
Conclusion:
Despite similar clinical and operative profiles, a posterior pericardial window with a single left pleural drain effectively reduces pericardial effusion and the incidence of postoperative AF following CABG surgery.
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