title: Systematic review and meta-analysis of randomized controlled trials assessing safety and efficacy of posterior pericardial drainage in patients undergoing heart surgery.
abstract: To investigate the potential beneficial effects of posterior pericardial drainage in patients undergoing heart surgery.
  
  
  
  Multiple online databases and relevant congress proceedings were screened for randomized controlled trials assessing the efficacy and safety of posterior pericardial drainage, defined as posterior pericardiotomy incision, chest tube to posterior pericardium, or both. Primary endpoint was in-hospital/30 days' cardiac tamponade. Secondary endpoints comprised death or cardiac arrest, early and late pericardial effusion, postoperative atrial fibrillation (POAF), acute kidney injury, pulmonary complications, and length of hospital stay.
  
  
  
  Nineteen randomized controlled trials that enrolled 3425 patients were included. Posterior pericardial drainage was associated with a significant 90% reduction of the odds of cardiac tamponade compared with the control group: odds ratio (95% confidence interval) 0.13 (0.07-0.25); P < .001. The corresponding event rates were 0.42% versus 4.95%. The odds of early and late pericardial effusion were reduced significantly in the intervention arm: 0.20 (0.11-0.36); P < .001 and 0.05 (0.02-0.10); P < .001, respectively. Posterior pericardial drainage significantly reduced the odds of POAF by 58% (P < .001) and was associated with significantly shortened (by nearly 1 day) overall length of hospital stay (P < .001). Reductions in postoperative complications translated into significantly reduced odds of death or cardiac arrest (P = .03) and numerically lower odds of acute kidney injury (P = .08).
  
  
  
  Posterior pericardial drainage is safe and simple technique that significantly reduces not only the prevalence of early pericardial effusion and POAF but also late pericardial effusion and cardiac tamponade. These benefits, in turn, translate into improved survival after heart surgery.
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland; Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz, Bydgoszcz, Poland.
authors.forename: Mirosław
authors.initials: M
authors.lastname: Gozdek
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Pawliszak
authors.affiliation: Chair and Clinic of Rehabilitation, Faculty of Health Sciences, Nicolaus Copernicus University in Toruń, Toruń, Poland.
authors.forename: Wojciech
authors.initials: W
authors.lastname: Hagner
authors.affiliation: Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz, Bydgoszcz, Poland.
authors.forename: Paweł
authors.initials: P
authors.lastname: Zalewski
authors.affiliation: Lung Cancer and Thoracic Surgery Department, Collegium Medicum in Bydgoszcz, Nicolaus Copernicus University, Toruń, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Kowalewski
authors.affiliation: Division of Cardiac Surgery, Department of Emergency and Organ Transplant, University of Bari Aldo Moro, Bari, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Paparella
authors.affiliation: Clinic for Cardiovascular Surgery, University Hospital and University of Bern, Bern, Switzerland.
authors.forename: Thierry
authors.initials: T
authors.lastname: Carrel
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland.
authors.forename: Lech
authors.initials: L
authors.lastname: Anisimowicz
authors.affiliation: Department of Cardiac Surgery, Dr Antoni Jurasz Memorial University Hospital in Bydgoszcz, Bydgoszcz, Poland; Department of Hygiene, Epidemiology and Ergonomics, Division of Ergonomics and Physical Effort, Collegium Medicum UMK in Bydgoszcz, Bydgoszcz, Poland. Electronic address: kowalewskimariusz@gazeta.pl.
authors.forename: Mariusz
authors.initials: M
authors.lastname: Kowalewski
mesh_terms: D000328:Adult; D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000517:prevention & control*; D006348:Cardiac Surgical Procedures / Q000009:adverse effects* / Q000401:mortality; D002305:Cardiac Tamponade / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D004322:Drainage / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010490:Pericardial Effusion / Q000175:diagnosis / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D065840:Protective Factors; D016032:Randomized Controlled Trials as Topic; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome
keywords: atrial fibrillation; cardiac tamponade; coronary artery bypass grafting; meta-analysis; pericardial effusion; posterior pericardiotomy; systematic review