Posterior left pericardiotomy reduces postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting surgery
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Published on: October 11, 2024
Nikhil Sahdev1, Guiqing Liu1, Sahar Hasanzade1
1Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Insights
Posterior pericardiotomy significantly reduces the risk and duration of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting. This surgical technique offers a promising approach to mitigate this common complication.
Area of Science:
- Cardiac Surgery
- Cardiology
- Thoracic Surgery
Background:
- Postoperative atrial fibrillation (POAF) is a frequent complication following coronary artery bypass grafting (CABG), increasing morbidity and mortality.
- Posterior pericardiotomy (PP) has shown potential in reducing POAF, but its widespread clinical adoption and real-world effectiveness require further investigation.
Purpose of the Study:
- To evaluate the impact of posterior pericardiotomy (PP) on the incidence and cumulative burden of postoperative atrial fibrillation (POAF) in a real-world setting.
- To assess the association between PP and POAF in patients undergoing CABG surgery.
Main Methods:
- A retrospective analysis of 2,480 patients who underwent CABG surgery between 2015 and 2022.
- Comparison of POAF incidence and duration between patients who had PP (n=806) and a control group without PP (n=1674).
- PP involved a 5-cm incision between the left inferior pulmonary vein and the phrenic nerve.
Main Results:
- Posterior pericardiotomy was associated with a 27.4% reduction in the odds of developing POAF (OR, 0.73; P=.023).
- Age was a significant risk factor for POAF (OR, 1.04 per year; P<.001).
- In multivariate analysis, PP remained protective, reducing POAF odds by 26.9% (OR, 0.73; P=.028), and significantly decreased POAF duration by 5.3% (P=.002).
Conclusions:
- Posterior pericardiotomy is an effective intervention for reducing both the likelihood and duration of postoperative atrial fibrillation after CABG.
- Further large-scale, multicenter trials are warranted to confirm these findings and explore the impact of PP on post-discharge outcomes.
Objective:
Atrial fibrillation (AF) is a common postoperative complication with an incidence of up to 10% to 33% after coronary artery bypass grafting surgery and is associated with worse morbidity and mortality. At present, studies have shown a promising reduction in postoperative AF (POAF) with posterior pericardiotomy (PP). However, there are limited data on the widespread use of PP amongst cardiac surgeons. This retrospective analysis assesses the influence of a real-world adoption of PP on the incidence and cumulative burden of POAF.
Methods:
Patients who underwent coronary artery bypass grafting surgery between 2015 and 2022 were analyzed. One group had PP as part of their surgical procedure whilst the control group did not. For both groups, the incidence of POAF was analyzed. PP was performed via a 5-cm incision between the left inferior pulmonary vein and the phrenic nerve.
Results:
Two thousand four hundred eighty patients were included in the analysis; 806 patients underwent PP and 1674 formed the control group. PP was associated with a 27.4% reduction in the odds of developing POAF (odds ratio, 0.73; 95% CI, 0.55-0.95; P = .023). Age was significantly associated with POAF, with a 4.3% increase in odds per additional year (odds ratio, 1.04; 95% CI, 1.03-1.06; P < .001). In the multivariate model for AF, PP remained significantly protective, reducing the odds of POAF by 26.9% (odds ratio, 0.73; 95% CI, 0.55-0.96; P = .028). Patients who underwent PP had significantly reduced cumulative POAF duration, with a 5.3% average reduction (P = .002).
Conclusions:
Posterior left pericardiotomy is associated with reduced odds and duration of POAF. A large, multicenter trial is indicated to confirm this finding as well as the influence of PP and POAF on postdischarge clinical outcomes.
