Should the pericardium be closed after an open-heart operation?

Area of Science:

• Cardiovascular Surgery
• Thoracic Surgery
• Surgical Outcomes

Background:

• The management of the pericardium after open-heart operations remains a subject of clinical debate.
• Deciding whether to close or leave the pericardium open can impact patient recovery and complication rates.

Purpose of the Study:

• To determine the optimal approach for pericardial management following open-heart surgery.
• To compare complication rates and patient outcomes between leaving the pericardium open and closing it.

Main Methods:

• A controlled clinical study involving 200 patients undergoing open-heart operations.
• Patients were randomized into two groups: 100 with pericardium closure and 100 with the pericardium left open.
• Outcomes assessed included complications, reoperations, graft patency, and mortality.

Main Results:

• Pericardial rub was more frequent in the closed group (14 vs 3 patients), but post-pericardiotomy syndrome incidence was similar.
• No late cardiac tamponade occurred in either group.
• Two early reoperations for bleeding occurred in the open group, none in the closed group.
• Graft failure rates were equal in both groups for revascularization procedures.

Conclusions:

• Closing the pericardium after open-heart operations is advisable.
• Pericardial closure does not adversely affect morbidity or mortality.
• Closing the pericardium enhances the safety of potential repeat cardiac explorations.