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. 2022 Dec 23:9:1090102.
doi: 10.3389/fcvm.2022.1090102. eCollection 2022.

Effect of posterior pericardiotomy in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials

Giovanni Jr Soletti  1 , Roberto Perezgrovas-Olaria  1 , Lamia Harik  1 , Mohamed Rahouma  1 , Arnaldo Dimagli  1 , Talal Alzghari  1 , Michelle Demetres  2 , Brenden A Bratton  1 , Mohammad Yaghmour  1 , Divyaam Satija  1 , Christopher Lau  1 , Leonard N Girardi  1 , Tomas A Salemo  3 , Mario Gaudino  1
Affiliations

Effect of posterior pericardiotomy in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials

Giovanni Jr Soletti et al. Front Cardiovasc Med. .

Abstract

Background: Posterior pericardiotomy (PP) has been shown to reduce the incidence of pericardial effusion and postoperative atrial fibrillation (POAF) after cardiac surgery. However, the procedure and the totality of its effects are poorly known in the cardiac surgery community. We performed a study-level meta-analysis of randomized controlled trials (RCTs) to evaluate the impact of PP in cardiac surgery patients.

Methods: A systematic literature search was conducted on three medical databases (Ovid MEDLINE, Ovid Embase, Cochrane Library) to identify RCTs reporting outcomes of patients that received a PP or no intervention after cardiac surgery. The primary outcome was the incidence of POAF. Key secondary outcomes were operative mortality, incidence of pericardial and pleural effusion, cardiac tamponade, length of stay (LOS), pulmonary complications, amount of chest drainage, need for intra-aortic balloon pump, and re-exploration for bleeding.

Results: Eighteen RCTs totaling 3,531 patients were included. PP was associated with a significantly lower incidence of POAF (odds ratio [OR] 0.45, 95% confidence interval [CI] 0.32-0.64, P < 0.0001), early (OR 0.18, 95% CI 0.10-0.34, P < 0.0001) and late pericardial effusion (incidence rate ratio 0.13, 95% CI 0.06-0.29, P < 0.0001), and cardiac tamponade (risk difference -0.02, 95% CI -0.04 to -0.01, P = 0.001). PP was associated with a higher incidence of pleural effusion (OR 1.42, 95% CI 1.06-1.90, P = 0.02), but not pulmonary complications (OR 0.82, 95% CI 0.56-1.19; P = 0.38). No differences in other outcomes, including operative mortality, were found.

Conclusions: PP is a safe and effective intervention that significantly decreases the incidence of POAF and pericardial effusion following cardiac surgery.

Systematic review registration: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=261485, identifier: CRD42021261485.

Keywords: cardiac surgery; meta-analysis; pericardial effusion; posterior pericardiotomy; postoperative atrial fibrillation.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Forest plot for postoperative atrial fibrillation. CI, confidence interval; OR, odds ratio; POAF, postoperative atrial fibrillation; PP, posterior pericardiotomy.
Figure 2
Figure 2
Forest plot for early pericardial effusion. CI, confidence interval; OR, odds ratio; PP, posterior pericardiotomy.
Figure 3
Figure 3
Forest plot for late pericardial effusion. CI, confidence interval; IRR, incidence rate ratio; PP, posterior pericardiotomy.
See this image and copyright information in PMC

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