Effects of posterior pericardiotomy on the incidence of pericardial effusion and atrial fibrillation after coronary revascularization.
BACKGROUND
The aim of this prospective, randomized study was to assess the efficacy of posterior pericardiotomy in decreasing the prevalence of pericardial effusion and postoperative atrial fibrillation (AF).


METHODS
The study was performed in 100 patients who underwent elective coronary artery bypass grafting surgery (CABG) between October 2003 and July 2005. They were randomized to receive posterior pericardiotomy (Group A) or no posterior pericardiotomy (Group B). A 4-cm longitudinal incision was made parallel and posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm in group A patients. Posterior pericardiotomy was not performed in group B patients.


RESULTS
Early pericardial effusion developed in 6 patients (12%) of group A and 21 patients (42%) of group B; no late pericardial effusion developed in group A, but did in 3 patients (6%) of group B. The number of patients who developed postoperative AF was significantly lower in the fenestration group compared with the control group (10% vs. 30%, p < 0.010). The overall incidence of supraventricular tachycardia in patients with early pericardial effusion was significantly higher than in patients without early pericardial effusion (18 patients vs. 9 patients).


CONCLUSIONS
These findings suggest that posterior pericardiotomy reduces the prevalence of early pericardial effusion and related AF by improving pericardial drainage in patients undergoing coronary artery bypass surgery.
Ekim
Hasan
H
Department of Cardiovascular Surgery, Yüzüncü Yýl University, Van, Turkey. drhasanekim@yahoo.com
Kutay
Veysel
V
Hazar
Abdüssemet
A
Akbayrak
Hakan
H
Başel
Halil
H
Tuncer
Mustafa
M
D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D001026:Coronary Artery Bypass; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009204:Myocardial Revascularization / Q000009:adverse effects*; D010490:Pericardial Effusion / Q000453:epidemiology / Q000209:etiology / Q000517:prevention & control*; D010492:Pericardiectomy / Q000379:methods*; D015995:Prevalence; D011446:Prospective Studies; D016896:Treatment Outcome