Xinxin Tang, MD: No financial relationships to disclose
Charlotte C. McEwen, MD: No financial relationships to disclose
Background: Postoperative atrial fibrillation (AF) is a frequent complication of cardiac surgery. Several randomized controlled trials (RCTs) have assessed whether posterior pericardiotomy reduces AF. We performed a systematic review and meta-analysis to summarize data on the safety and efficacy of posterior pericardiotomy.
METHODS AND RESULTS: We searched MEDLINE, EMBASE, Web of Science, and the Cochrane Central Register of Controlled Trials (CENTRAL) for RCTs from inception to March 11, 2023. We also searched the grey literature. In duplicate, reviewers screened references and potentially eligible full-texts, collected data, and assessed risk of bias. We pooled data using a random effects model.
After reviewing 2452 citations, we included 18 RCTs with a total of 3558 participants (1771 in the pericardiotomy group and 1787 in the control group). Of participants, 13.3% (235/1771) and 25.2% (452/1787) developed AF in the pericardiotomy and control groups, respectively. The incidence of AF (RR = 0.53, 95% CI 0.40-0.70, I2 = 67%), pericardial effusion (RR = 0.36, 95% CI 0.17-0.73, I2 = 100%), and surgical re-exploration (RR = 0.61, 95% CI 0.41-0.91, I2 = 0%) were significantly lower in the pericardiotomy group. In contrast, pleural effusion requiring intervention (RR = 1.70, 95% CI 1.12-2.57, I2 = 15%) was significantly higher in the pericardiotomy group. We found no significant difference in all-cause mortality, hospital or ICU length of stay, time on bypass, and cross-clamp time (Table 1).
Conclusion: Posterior pericardiotomy is safe and effective in preventing AF after cardiac surgery.
