Related Experiment Video
Updated: Jan 12, 2026
Prone Lateral Minimally Invasive Retropleural Corpectomy Using a Rotatable Radiolucent Jackson Table
Published on: July 3, 2025
Posterior pericardiotomy: An effective strategy for reducing post-coronary artery bypass grafting complications, with
Muneeb Khawar1, Syed Abdullah Shah1, Ayesha Khan2
1Department of Medicine, King Edward Medical University, Lahore 54000, Punjab, Pakistan.
Insights
Posterior pericardiotomy (PP) significantly reduces postoperative atrial fibrillation, effusions, and tamponade after coronary artery bypass grafting (CABG). While it shortens hospital stays, PP also increases the risk of pleural effusion.
Area of Science:
- Cardiovascular Surgery
- Thoracic Surgery
- Critical Care Medicine
Background:
- Coronary artery bypass grafting (CABG) is frequently complicated by postoperative atrial fibrillation (POAF) and pericardial effusion.
- Posterior pericardiotomy (PP) is a surgical technique that involves incising the posterior pericardium to facilitate drainage.
- The efficacy and safety of PP in preventing post-CABG complications require thorough evaluation.
Purpose of the Study:
- To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating the efficacy of posterior pericardiotomy (PP) in reducing postoperative complications following coronary artery bypass grafting (CABG).
Main Methods:
- A systematic review and meta-analysis of 20 RCTs involving 5331 adult CABG patients comparing intraoperative PP versus no PP.
- Data were extracted from PubMed, Cochrane, ClinicalTrials.gov, and Ovid.
- Primary outcome was POAF; secondary outcomes included effusions, tamponade, length of stay, and bleeding revisions. Random-effects models were used for analysis.
Main Results:
- PP significantly reduced the incidence of POAF (RR=0.48), cardiac tamponade (RR=0.16), and both early (RR=0.31) and late (RR=0.11) pericardial effusions.
- Hospital stay was reduced by an average of 1.23 days (MD=-1.23).
- However, PP increased the risk of pleural effusion (RR=1.46) with no significant impact on mortality, ICU stay, or bleeding revisions.
Conclusions:
- Posterior pericardiotomy is an effective strategy for reducing POAF, pericardial effusions, and cardiac tamponade after CABG, leading to shorter hospitalizations.
- The increased risk of pleural effusion associated with PP warrants consideration.
- Heterogeneity was observed in certain outcomes, highlighting the need for careful interpretation.
Background:
Postoperative complications such as atrial fibrillation and pericardial effusion are frequent after coronary artery bypass grafting (CABG), contributing to increased morbidity and prolonged hospital stays. Posterior pericardiotomy (PP), a surgical technique involving incision of the posterior pericardium to allow drainage, has been suggested as a preventive measure. However, its overall efficacy and safety profile, including potential risks like pleural effusion, require comprehensive evaluation amid varying study qualities. We hypothesized that PP reduces key post-CABG complications compared to standard care.
Aim:
To determine the efficacy of PP in reducing postoperative complications following CABG.
Methods:
This systematic review and meta-analysis included randomized controlled trials (RCTs) from PubMed, Cochrane, ClinicalTrials.gov, and Ovid, comparing PP vs no PP in adult CABG patients. Studies were conducted in tertiary care hospital settings. Twenty RCTs with 5331 participants were selected based on predefined inclusion criteria. The intervention involved intraoperative PP. Primary outcome was postoperative atrial fibrillation (POAF); secondary outcomes included effusions, tamponade, hospital/intensive care unit stay, and bleeding revisions. Risk ratios (RRs), mean differences, and 95% confidence intervals (CIs) were calculated using random-effects models; heterogeneity assessed via I 2 statistic.
Results:
Twenty RCTs analyzed 5331 patients (2665 with PP vs 2666 without). PP significantly lowered POAF (10% vs 21%; RR = 0.48, 95%CI: 0.36-0.65, P < 0.00001; I 2 = 70%), cardiac tamponade (0.5% vs 3%; RR = 0.16, 95%CI: 0.08-0.34, P < 0.00001; I 2 = 0%), early pericardial effusion (2% vs 6%; RR = 0.31, 95%CI: 0.14-0.68, P = 0.004; I 2 = 96%), and late pericardial effusion (1% vs 9%; RR = 0.11, 95%CI: 0.05-0.21, P < 0.00001; I 2 = 0%). Hospital stay decreased (mean difference = -1.23 days, 95%CI: -1.87 to -0.59, P = 0.0002; I 2 = 85%). Pleural effusion risk increased (25% vs 17%; RR = 1.46, 95%CI: 1.21-1.76, P < 0.0001; I 2 = 0%). No significant effects on mortality (RR = 0.92, 95%CI: 0.48-1.76, P = 0.80; I 2 = 0%), intensive care unit stay, or bleeding revisions.
Conclusion:
PP effectively reduces POAF, pericardial effusions, tamponade, and hospital stay in CABG patients, though it increases pleural effusion risk and shows heterogeneity in some outcomes.
Related Concept Videos
01:17Pericarditis III: Medical Management
01:28Cardiomyopathy VII: Pre and Post Operative Nursing Management