The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery

Authors

  • Canturk Cakalagaoglu
  • Cengiz Koksal
  • Ayse Baysal
  • Gokhan Alıcı
  • Birol Ozkan
  • Kamil Boyacioglu
  • Mehmet Tasar
  • Emine Banu Atasoy
  • Hasan Erdem
  • Ali Metin Esen
  • Mete Alp

DOI:

https://doi.org/10.1532/HSF98.20111128

Abstract

Aim: The goal was to determine the effectiveness of the posterior pericardiotomy technique in preventing the development of early and late pericardial effusions (PEs) and to determine the role of anxiety level for the detection of late pericardial tamponade (PT).

Materials and Methods: We divided 100 patients randomly into 2 groups, the posterior pericardiotomy group (n = 50) and the control group (n = 50). All patients undergoing coronary artery bypass grafting surgery (CABG), valvular heart surgery, or combined valvular and CABG surgeries were included. The posterior pericardiotomy technique was performed in the first group of 50 patients. Evaluations completed preoperatively, postoperatively on day 1, before discharge, and on postoperative days 5 and 30 included electrocardiographic study, chest radiography, echocardiographic study, and evaluation of the patient's anxiety level. Postoperative causes of morbidity and durations of intensive care unit and hospital stays were recorded.

Results: The 2 groups were not significantly different with respect to demographic and operative data (P > .05). Echocardiography evaluations revealed no significant differences between the groups preoperatively; however, before discharge the control group had a significantly higher number of patients with moderate, large, and very large PEs compared with the pericardiotomy group (P < .01). There were 6 cases of late PT in the control group, whereas there were none in the pericardiotomy group (P < .05). Before discharge and on postoperative day 15, the patients in the pericardiotomy group showed significant improvement in anxiety levels (P = .03 and .004, respectively). No differences in postoperative complications were observed between the 2 groups.

Conclusion: Pericardiotomy is a simple, safe, and effective method for reducing the incidence of PE and late PT after cardiac surgery. It also has the potential to provide a better quality of life.

References

Alkhulaifi AM, Speechly-Dick ME, Swanton RH, Pattison V, Pugsley WB. 1996. The incidence of significant pericardial effusion and tamponade following major aortic surgery. J Cardiovasc Surg 37:385-9.nAngelini GD, Penny WI, El-Ghamary F. 1987. The incidence and significance of early pericardial effusion after open heart surgery. Eur J Cardiothorac Surg 1:165-8.nBakhshandeh AR, Salehi M, Radmehr H, Sattarzadeh R, Nasr AR, Sadeghpour AH. 2009. Postoperative pericardial effusion and posterior pericardiotomy related. Asian Cardiovasc Thorac Ann 17:477-9.nBryan AI, Angelini GD. 1990. Pericardial effusion after open heart surgery. Thorax 45:655-6.nDeValeria PA, Baumgartner WA, Casale AS, et al. 1991. Current indications, risks, and outcome after pericardiectomy. Ann Thorac Surg 52:219-24.nEkim H, Kutay V, Hazar A, Akbayrak H, Ba?el H, Tuncer M. 2006. Effects of posterior pericardiotomy on the incidence of pericardial effusion and atrial fibrillation after coronary revascularization. Med Sci Monit 12:CR431-4.nErdil N, Nisanodlu V, Kosar F, Akgul F, Cihan HB, Battaloglu B. 2005. Effect of posterior pericardiotomy on early and late pericardial effusion after valve replacement. J Card Surg 20:257-60.nFarsak B, Gunaydin S, Tokmakoglu H, Kandemir O, Yorgancioglu C, Zorlutuna Y. 2002. Posterior pericardiotomy reduces the incidence of supra-ventricular arrhythmias and pericardial effusion after coronary artery bypass grafting. Eur J Cardiothorac Surg 22:278-81.nGeorghiou GP, Porat E, Fuks A, Vidne BA, Saute M. 2009. Video-assisted pericardial fenestration for effusions after cardiac surgery. Asian Cardiovasc Thorac Ann 17:480-2.nHamilton M. 1959. The assessment of anxiety status by rating. Br J Med Psychol 32:50-5.nJeffrey TK, Nibal AH, Natesa GP. 2002. Postoperative cardiac tamponade in the modern surgical era. Ann Thorac Surg 74:1148-53.nKouchoukos NT, Blackstone EH, Doty DB. 2003. Postoperative care. In: Kouchoukos NT, Blackstone EH, Doty DB, Hanley FL, Karp RB. Kirklin/Barratt-Boyes cardiac surgery. 3rd ed. Philadelphia, Pa: Elsevier. p 230-42.nMangi AA, Palacios IF, Torchiana DF. 2002. Catheter pericardiocentesis for delayed tamponade after cardiac valve operation. Ann Thorac Surg 73:1479-83.nMulay A, Kirk AJB, Angelini GD, Wishheart JD, Hutter JA. 1995. Posterior pericardiotomy reduces the incidence of supraventricular arrhythmias following coronary artery bypass surgery. Eur Cardiothorac Surg 9:150-2.nPepi M, Muratori M, Barbier P, et al. 1994. Pericardial effusion after cardiac surgery: incidence, site, size, and hemodynamic consequences. Br Heart J 72:327-31.n

Published

2012-04-26

How to Cite

Cakalagaoglu, C., Koksal, C., Baysal, A., Alıcı, G., Ozkan, B., Boyacioglu, K., Tasar, M., Atasoy, E. B., Erdem, H., Esen, A. M., & Alp, M. (2012). The Use of Posterior Pericardiotomy Technique to Prevent Postoperative Pericardial Effusion in Cardiac Surgery. The Heart Surgery Forum, 15(2), E84-E89. https://doi.org/10.1532/HSF98.20111128

Issue

Section

Articles

Most read articles by the same author(s)