Coronary interventions

Posterior pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: a systematic review and meta-analysis of 25 randomised controlled trials

EuroIntervention 2023;19:e305-e317. DOI: 10.4244/EIJ-D-22-00948

Ahmed Abdelaziz
Ahmed Abdelaziz1,2, MBBCh; Abdelrahman H. Hafez1,2, MBBCh; Ahmed Elaraby1,2, MBBCh; Merna Raafat Roshdy1,3, MBBCh; Mohamed Abdelaziz1,2, MBBCh; Moemen A. Eltobgy1,4, MBBCh; Hanaa Elsayed1,5, MBBCh; Mohamed El-Samahy1,5, MBBCh; Nada Abdallah Elbehbeh1,5, MBBCh; Kerollos George Philip1,3, MBBCh; Arwa Mohamed Abdelaty1,5, MBBCh; Marwa Abdelazim Rizk1,5, MBBCh; Mohamed Al-Tawil1,6, MBBCh; Hadeer Elsaeed AboElfarh1,7, MBBCh; Alaa Ramadan1,8, MBBCh; Hazem S. Ghaith1,2, MBBCh; Engy A. Wahsh1,9, MBBCh; Basel Abdelazeem1,10,11, MD; Badr Fayed12, MD
1. Medical Research Group of Egypt (MRGE), Cairo, Egypt; 2. Faculty of Medicine, Al-Azhar University, Cairo, Egypt; 3. Faculty of Medicine, Sohag University, Sohag, Egypt; 4. Kasr Al Ainy School of Medicine, Cairo University, Cairo, Egypt; 5. Faculty of Medicine, Zagazig University, Zagazig, Egypt; 6. Faculty of Medicine, Al-Quds University, Jerusalem, Palestine; 7. Mansoura Manchester Programme for Medical Education, Faculty of Medicine, Mansoura University, Mansoura, Egypt; 8. Faculty of Medicine, South Valley University, Qena Governorate, Egypt; 9. Department of Clinical Pharmacy, Faculty of Pharmacy, October 6 University, Giza, Egypt; 10. McLaren Flint Hospital, Flint, MI, USA; 11. Michigan State University, East Lansing, MI, USA; 12. Cardiothoracic Surgery Department, Faculty of Medicine, Port Said University, Port Said, Egypt

Background: Atrial fibrillation (AF) associated with postoperative pericardial effusion is the most commonly reported adverse event after cardiac surgery.

Aims: We aimed to determine the role of posterior pericardiotomy in preventing postoperative AF (POAF).

Methods: We searched PubMed, Scopus, Web of Science, Ovid, and EBSCO from inception until 30 June 2022. We included randomised clinical trials (RCTs) that compared posterior pericardiotomy (PP) versus control (no PP) in patients undergoing cardiac surgery. The primary endpoint was the incidence of POAF after cardiac surgery. The secondary endpoints were supraventricular arrhythmias, early/late pericardial effusion, pericardial tamponade, pleural effusion, length of hospital/intensive care unit stay, intra-aortic balloon pump use, revision surgery for bleeding, and mortality.

Results: Twenty-five RCTs comprising 4,467 patients were included in this systematic review and meta-analysis. The overall incidence rate of POAF was 11.7% in the PP group compared with 23.67% in the no PP or control group, with a significant decrease in the risk of POAF following PP (odds ratio [OR] 0.49, 95% confidence interval [CI]: 0.38-0.61). Compared with the control group, the risk of supraventricular tachycardia (OR 0.66, 95% CI: 0.43-0.89), early pericardial effusion (OR 0.32, 95% CI: 0.22-0.46), late pericardial effusion (OR 0.15, 95% CI: 0.09-0.25), and pericardiac tamponade (OR 0.18, 95% CI: 0.10-0.33) were lower in the PP group.

Conclusions: PP is an effective intervention for reducing the risk of POAF after cardiac surgery. Also, PP is economically efficient in terms of decreasing the length of hospital stay.

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