 |
 |
 |
Posterior Pericardiotomy for Atrial Fibrillation Prophylaxis: A Single Center Retrospective Analysis of Over 1,000 CABG Patients
Mark R. Lutz1, Shaelyn Cavanaugh2, Karikehalli Dilip3, Ahmad Nazem3, Anton Cherney3, Zhandong Zhou3, *Charles J. Lutz3
1SUNY Upstate Medical University, Syracuse, New York, United States, 2Department of Surgery, University of Rochester, Rochester, New York, United States, 3St. Joseph's Health Center, Syracuse, New York, United States
Objective:
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery, contributing to increased morbidity, prolonged hospital stays, and elevated healthcare costs. Intraoperative posterior pericardiotomy, a surgical technique to facilitate drainage of pericardial effusions, has emerged as a potential prophylactic measure. Despite promising results from early studies, the efficacy of posterior pericardiotomy in reducing POAF remains uncertain. This single-center retrospective study evaluates the impact of intraoperative posterior pericardiotomy on the incidence of POAF in patients undergoing cardiac surgery, aiming to clarify its role in POAF prophylaxis.
Methods:
We identified 1,082 patients without atrial fibrillation (AF) who underwent elective or urgent isolated coronary artery bypass grafting (CABG) at our institution between 2022 and 2024. Emergent and redo procedures were excluded. Patients were stratified simply based on whether they received prophylactic posterior pericardiotomy: No (n=825) or Yes (n=195). Preoperative characteristics, intraoperative variables, and postoperative outcomes were compared between the two groups.
Results:
Preoperative characteristics were similar between groups aside from an increased incidence of cerebrovascular disease (31.0% vs 21.0%; P = .002) in the cohort not receiving posterior pericardiotomy. Intraoperatively, significantly more cases incorporating a posterior pericardiotomy were performed without the use of cardiopulmonary bypass (42.0% vs 21.7%; P < .001). In the cases involving the use of cardiopulmonary bypass (CPB), the time spent on CPB was significantly longer in the cohort receiving posterior pericardiotomy (106.73 min vs 99.02 min; P = .003). Measured postoperative outcomes were similar between the two groups, including the development of POAF (27.6% vs 27.6%; P = .998).
Conclusion:
In this single-center retrospective study, the use of intraoperative posterior pericardiotomy in isolated CABG patients did not reduce the incidence of POAF, with identical rates observed between the two groups. In contrast to other reports, this retrospective study suggests that posterior pericardiotomy does not reduce the incidence of POAF and could potentially increase operative complexity. Further retrospective and randomized studies are needed to explore its utility.
Back to 2025 Abstracts
