The effects of posterior pericardiotomy on pericardial effusion, tamponade, and atrial fibrillation after coronary artery surgery.
BACKGROUND
Pericardial effusion and atrial fibrillation occur commonly after coronary artery surgery.


OBJECTIVE
A prospective randomized clinical trial was conducted to evaluate the effects of posterior pericardiotomy on the occurrence of pericardial effusion, tamponade, and atrial fibrillation.


METHODS
The study group consisted of 96 patients (77 male and 19 female) at a mean age of 58.1 ± 9.8 years. The patients were randomly assigned to one of three study groups: patients undergoing posterior pericardiotomy (group I, n = 30), controls (group II, n = 33), and patients with additional posterior pericardial drainage tubes (28 mm) who did not undergo posterior pericardiotomy (group III, n = 33).


RESULTS
Postoperative hospitalization (p = 0.03; 11.56 ± 10.64) and reoperation due to tamponade (p = 0.019; 12.1%) were significantly higher in group II. Extensive pericardial effusions were detected in one patient on the first postoperative day (group II, n = 1), in one patient on the fifth postoperative day (group III, n = 1), and in one patient on the 30(th) day after the operation (group III, n = 1). Pericardial effusion exhibited regression in group I on postoperative day 30 (p = 0.028). A higher rate of postoperative atrial fibrillation was noted in group I, but no significant differences were found between the groups with regard to postoperative atrial fibrillation.


CONCLUSIONS
Patients who did not undergo posterior pericardiotomy or did not receive posterior chest tubes exhibited residual pericardial effusion, required longer hospitalization, and had to be reoperated due to tamponade. Both posterior pericardiotomy and the use of posterior tubes are effective in the early postoperative period.
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Mehmet
M
Kaya
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Taner
T
İyigün
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Pınar
P
Yazıcı
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Yasin
Y
Melek
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Safa
S
Göde
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Salih
S
Güler
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Mehmet
M
Karaçalılar
Department of Cardiology, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Muhammet Hulusi
MH
Satılmışoğlu
Department of Cardiovascular Surgery, Istanbul Mehmet Akif Ersoy Thoracic and Cardiovascular Surgery Training and Research Hospital, Istanbul, Turkey.
Ersin
E
Erek
atrial fibrillation; cardiac tamponade; pericardial effusion; posterior pericardiotomy