Pericardial Closure Preserves Early Right Ventricular Function After Cardiac Surgery: A Retrospective Cohort Study

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardiovascular Physiology

Background:

• Perioperative right ventricular (RV) dysfunction is a common complication after cardiac surgery, associated with adverse outcomes.
• Loss of pericardial support during surgery may contribute to RV dysfunction.

Purpose of the Study:

• To investigate whether closing the pericardium during cardiac surgery preserves early postoperative RV function.
• To evaluate the impact of pericardial closure on RV longitudinal function.

Main Methods:

• A comparative study of patients undergoing cardiac surgery with pericardial closure versus an open pericardium.
• Co-primary endpoints included early postoperative RV longitudinal function assessed by tricuspid annular plane systolic excursion (TAPSE) and tricuspid annular systolic velocity (TASV).
• Adjusted comparisons utilized analysis-of-covariance and sensitivity analyses with linear mixed-effects models.

Main Results:

• Pericardial closure was independently associated with improved early RV longitudinal function.
• Adjusted mean difference for TAPSE was 1.531 mm (p = 0.033) and for TASV was 1.694 cm/s (Holm-adjusted p = 0.018) in favor of pericardial closure.
• Sensitivity analyses confirmed these findings.

Conclusions:

• Pericardial closure is independently linked to better early RV longitudinal function after cardiac surgery.
• These results, adjusted for baseline imbalances, support considering pericardial closure to maintain RV performance.
• Further confirmation in prospective trials is recommended.