Posterior Pericardial Window and a Single Pleural Drain: A Dual Defence Against Post-CABG Pericardial Effusion and Atrial Fibrillation

Abstract

Background: Postoperative new atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) and is often associated with postoperative pericardial effusion. We aimed to investigate the effectiveness of a posterior pericardial window (PPW) with a single left pleural drain in reducing post-CABG pericardial effusion and atrial fibrillation without mediastinal chest drains.

Methods: This descriptive observational study evaluated age and sex-adjusted isolated elective on-pump CABG patients into two groups: PPW with only left pleural chest drains and control (routine multiple mediastinal and pleural chest drains. We performed continuous telemonitoring for 96 hours after surgery to assess heart rhythm, followed by daily electrocardiograms. Bedside echocardiography was conducted on postoperative day 4 to check for pericardial effusion.

Results: This study evaluated age and sex-adjusted 250 CABG patients, with male predominance (80%) and identical comorbidities between study groups. We found similar age (61.5 ±7.5 vs 62.6 ±6.2, P =0.40) and male sex (86.9% vs 74.8%, P =0.13) between the PPW and control groups. Additionally, the sociodemographic and intraoperative variables were the same across the study groups (P >0.05). The occurrence of >1cm pericardial effusions (0.8% vs 14.1%, P <0.001) and postoperative AF (6.9% vs 19.3%, P =0.002) occurrence was significantly lower in the PPW compared to the control group.

Conclusion: Despite similar clinical and operative profiles, a posterior pericardial window with a single left pleural drain effectively reduces pericardial effusion and the incidence of postoperative AF following CABG surgery.

Keywords: atrial fibrillation; coronary artery bypass graft; pericardial window; pericardiotomy.

Figure 1

The 3D bar chart compares the mean ±SD values of the number of distal anastomoses, ventilation time in hours, total blood loss in mL, and aortic XC (cross-clamp) time in minutes between the study groups. Here, the mean ±SD values of the number of distal anastomoses (P=0.06), ventilation time (P=0.70), aortic XC time (P=0.15), and total blood loss (P=0.40) were similar between the study groups. The P-value is calculated from an unpaired t-test, as appropriate.

Figure 2

The clustered bar chart illustrates the incidence of POAF and PE, with mean LOS among the study groups. Here, POAF- postoperative atrial fibrillation, PE- pericardial effusion, LOS- length of stay. The P-value is calculated from chi-square and unpaired t-test, as appropriate. The PE (14.1% vs 0.8%, P <0.001) and POAF (19.3% vs 6.9%, P =0.002) were significantly lower among the pericardial window group than the control population, whereas the length of hospital stay was similar (9.8 ±3.5 vs 10.5 ±2.5, P= 0.38).