title: Posterior pericardiotomy in cardiac surgery: systematic review and meta-analysis.
abstract: This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. A value of p < 0.1 for Q test or I(2 )> 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 20 studies. After screening, 12 suitable trials were identified, which reported outcomes of 2052 patients undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for atrial fibrillation; odds ratio 0.32 [0.15-0.67] p = 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04-0.19] p = 0.000 for early pericardial effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late pericardial effusion; odds ratio 1.64 [1.23-2.20] p = 0.001 for pleural effusion, odds ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean difference = 0.01 [-0.12 to 0.14] p = 0.8 for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher.
authors.affiliation: Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran S.alihassan.cardiosurg@gmail.com.
authors.forename: Sadeq
authors.initials: S
authors.lastname: Ali-Hasan-Al-Saegh
authors.affiliation: Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Seyed Jalil
authors.initials: SJ
authors.lastname: Mirhosseini
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, West German Heart Center, Essen University Hospital, Essen, Germany.
authors.forename: Oliver
authors.initials: O
authors.lastname: Liakopoulos
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Anton
authors.initials: A
authors.lastname: Sabashnikov
authors.affiliation: Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Hamid Reza
authors.initials: HR
authors.lastname: Dehghan
authors.affiliation: Department of Medicine III, University of Heidelberg, Heidelberg, Germany.
authors.forename: Farbod
authors.initials: F
authors.lastname: Sedaghat-Hamedani
authors.affiliation: Department of Medicine III, University of Heidelberg, Heidelberg, Germany.
authors.forename: Elham
authors.initials: E
authors.lastname: Kayvanpour
authors.affiliation: Department of Cardiovascular Surgery, Herzchirurgie Klinikum, Karlsruhe, Germany.
authors.forename: Naser
authors.initials: N
authors.lastname: Ghaffari
authors.affiliation: Department of Cardiovascular Surgery, Herzchirurgie Klinikum, Karlsruhe, Germany.
authors.forename: Vahid
authors.initials: V
authors.lastname: Vahabzadeh
authors.affiliation: Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mahdi
authors.initials: M
authors.lastname: Aghabagheri
authors.affiliation: Yazd Cardiovascular Research Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran.
authors.forename: Mohammad Reza
authors.initials: MR
authors.lastname: Mozayan
authors.affiliation: Department of Cardiothoracic Transplantation and Mechanical Circulatory Support, Royal Brompton & Harefield NHS Foundation Trust, London, UK.
authors.forename: Aron-Frederik
authors.initials: AF
authors.lastname: Popov
mesh_terms: D001281:Atrial Fibrillation / Q000453:epidemiology / Q000209:etiology; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000379:methods; D002305:Cardiac Tamponade / Q000453:epidemiology / Q000209:etiology; D006801:Humans; D015994:Incidence; D007902:Length of Stay / Q000706:statistics & numerical data; D010490:Pericardial Effusion / Q000453:epidemiology / Q000209:etiology*; D010492:Pericardiectomy / Q000009:adverse effects*; D013617:Tachycardia, Supraventricular / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome
keywords: atrial fibrillation; cardiac tamponade; length of stay; pericardial effusion; pericardiectomy; pleural effusion