Postoperative Pericardial Effusion and Posterior Pericardiotomy, Related or Not?
Introduction: Large pericardial effusions after cardiac surgery develop in 30% of patients and reach their maximum size on approximately day 10 postoperatively. Tamponade develops in approximately 1% of patients with large pericardial effusions. Effusion may be prevented by posterior pericardiotomy, but its role and possible adverse consequences are controversial. We sought to further investigate the effectiveness of this technique.
Method: This prospective randomized case-control study was carried out on 410 patients, mean age 68.4 ± 9.2 years, who underwent coronary artery bypass graft surgery alone or combined with valve surgery during the period between April 2005 and May 2006. A 4-cm longitudinal incision was made parallel and posterior to the phrenic nerve in the pericardiotomy group. Echocardiographic study was performed at the time of discharge and 15 and 30 days after surgery.
Results: After 15 and 30 days postsurgery, respectively, 178 (90.2%) and 192 (97%) of patients from the pericardiotomy group and none from the conventional group were free of effusion (P < .05).
Conclusion: Posterior pericardiotomy is easy to perform and is a safe and effective means to prevent postoperative effusion and its early and delayed adverse consequences.
Appleton CP, Hatle LK, Popp RL. 1988. Cardiac tamponade and pericardial effusion. J Am Coll Cardiol 11:1020-30.nKuralay E, Ozal E, Demirkilic U. 1999. Effect of posterior pericardiotomy on postoperative supraventricular arrhythmias and late pericardial effusion (posterior pericardiotomy). J Thoracic Cardiovasc Surg 118: 492-5.nMcKaughan BC, Schaff HV, Piehier JM, et al. 1985. Early and late results of pericardiectomy for constrictive pericarditis. J Thorac Cardiovasc Surg 89:340-50.nMulay A, Kirk AJ, Angelini GD, Wisheart JD, Hutter JA. 1995. Posterior pericardiotomy reduces the incidence of supra-ventricular arrhythmias following coronary artery bypass surgery. Eur J Cardiothorac Surg 1995;9:150-2.nKouchouko NT, Eugene H Blackstone EH, Doty DB, et al. 2003. Postoperative care. In: Cardiac surgery. 3rd ed. Philadelphia: Elsevier Science. p. 230.nRao W, Komeda M, Weisel RD, et al. 1999. Should the pericardium be closed routinely after heart operations? Ann Thorac Cardiovasc Surg 67:484-8.nReddy PS, Curtiss EL, Uretsky BF. 1990. Spectrum of hemodynamic changes in cardiac tamponade. Am J Cardiol 66:1487-91.n