Posterior left pericardiotomy reduces postoperative atrial fibrillation in patients undergoing coronary artery bypass grafting surgery
File(s)
Published version
Author(s)
Type
Journal Article
Abstract
Objective:
Atrial fibrillation (AF) is a common postoperative complication with an incidence of up to 10% to 33% after coronary artery bypass grafting surgery and is associated with worse morbidity and mortality. At present, studies have shown a promising reduction in postoperative AF (POAF) with posterior pericardiotomy (PP). However, there are limited data on the widespread use of PP amongst cardiac surgeons. This retrospective analysis assesses the influence of a real-world adoption of PP on the incidence and cumulative burden of POAF.
Methods:
Patients who underwent coronary artery bypass grafting surgery between 2015 and 2022 were analyzed. One group had PP as part of their surgical procedure whilst the control group did not. For both groups, the incidence of POAF was analyzed. PP was performed via a 5-cm incision between the left inferior pulmonary vein and the phrenic nerve.
Results:
Two thousand four hundred eighty patients were included in the analysis; 806 patients underwent PP and 1674 formed the control group. PP was associated with a 27.4% reduction in the odds of developing POAF (odds ratio, 0.73; 95% CI, 0.55-0.95; P = .023). Age was significantly associated with POAF, with a 4.3% increase in odds per additional year (odds ratio, 1.04; 95% CI, 1.03-1.06; P < .001). In the multivariate model for AF, PP remained significantly protective, reducing the odds of POAF by 26.9% (odds ratio, 0.73; 95% CI, 0.55-0.96; P = .028). Patients who underwent PP had significantly reduced cumulative POAF duration, with a 5.3% average reduction (P = .002).
Conclusions:
Posterior left pericardiotomy is associated with reduced odds and duration of POAF. A large, multicenter trial is indicated to confirm this finding as well as the influence of PP and POAF on postdischarge clinical outcomes.
Atrial fibrillation (AF) is a common postoperative complication with an incidence of up to 10% to 33% after coronary artery bypass grafting surgery and is associated with worse morbidity and mortality. At present, studies have shown a promising reduction in postoperative AF (POAF) with posterior pericardiotomy (PP). However, there are limited data on the widespread use of PP amongst cardiac surgeons. This retrospective analysis assesses the influence of a real-world adoption of PP on the incidence and cumulative burden of POAF.
Methods:
Patients who underwent coronary artery bypass grafting surgery between 2015 and 2022 were analyzed. One group had PP as part of their surgical procedure whilst the control group did not. For both groups, the incidence of POAF was analyzed. PP was performed via a 5-cm incision between the left inferior pulmonary vein and the phrenic nerve.
Results:
Two thousand four hundred eighty patients were included in the analysis; 806 patients underwent PP and 1674 formed the control group. PP was associated with a 27.4% reduction in the odds of developing POAF (odds ratio, 0.73; 95% CI, 0.55-0.95; P = .023). Age was significantly associated with POAF, with a 4.3% increase in odds per additional year (odds ratio, 1.04; 95% CI, 1.03-1.06; P < .001). In the multivariate model for AF, PP remained significantly protective, reducing the odds of POAF by 26.9% (odds ratio, 0.73; 95% CI, 0.55-0.96; P = .028). Patients who underwent PP had significantly reduced cumulative POAF duration, with a 5.3% average reduction (P = .002).
Conclusions:
Posterior left pericardiotomy is associated with reduced odds and duration of POAF. A large, multicenter trial is indicated to confirm this finding as well as the influence of PP and POAF on postdischarge clinical outcomes.
Date Issued
2025-06-01
Date Acceptance
2025-04-13
Citation
JTCVS Open, 2025, 25, pp.120-125
ISSN
2666-2736
Publisher
Elsevier
Start Page
120
End Page
125
Journal / Book Title
JTCVS Open
Volume
25
Copyright Statement
Crown Copyright © 2025 Published by Elsevier Inc. on behalf of The American Association for Thoracic Surgery. This is an open access article under the CC BY-NC- ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/40631027
Subjects
atrial fibrillation
Cardiac & Cardiovascular Systems
CARDIAC-SURGERY
Cardiovascular System & Cardiology
duration
Life Sciences & Biomedicine
pericardiotomy
posterior
Respiratory System
Science & Technology
Surgery
Publication Status
Published
Coverage Spatial
Netherlands
Date Publish Online
2025-05-03