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San TMM, Han KPP, Ismail M, Thu LM, Thet MS. Pericardiotomy and atrial fibrillation after isolated coronary artery bypass grafting: A systematic review and meta-analysis of 16 randomised controlled trials. CARDIOVASCULAR REVASCULARIZATION MEDICINE 2024; 66:27-32. [PMID: 38584081 DOI: 10.1016/j.carrev.2024.03.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Revised: 03/21/2024] [Accepted: 03/21/2024] [Indexed: 04/09/2024]
Abstract
BACKGROUND Atrial fibrillation (AF) and pericardial effusion are notable complications following coronary artery bypass grafting (CABG), contributing to increased morbidity and healthcare costs. Posterior pericardiotomy has been proposed to mitigate these complications. This systematic review and meta-analysis aim to evaluate the efficacy of posterior pericardiotomy in reducing postoperative AF and pericardial effusion in isolated CABG patients. MATERIALS AND METHODS A comprehensive literature search, adhering to PRISMA guidelines, was conducted across PubMed, MEDLINE via Ovid, Embase, Scopus, the Central Register of Controlled Trials (CENTRAL), and ClinicalTrials.gov up to December 2023. Only randomised controlled trials (RCTs) comparing prophylactic posterior pericardiotomy to control treatments in adult CABG patients were included. The primary outcomes assessed were the incidences of postoperative AF and pericardial effusion. RESULTS The meta-analysis incorporated 16 RCTs with a total of 2414 patients. The findings demonstrated a significant reduction in the incidence of postoperative AF (Odds Ratio = 0.34, 95 % CI: 0.25-0.48, P < 0.00001) and pericardial effusion (Odd Ratio = 0.24, 95 % CI: 0.15-0.38, P < 0.0001) in the group undergoing posterior pericardiotomy. However, the analysis revealed substantial heterogeneity and publication bias in the included studies. CONCLUSION The posterior pericardiotomy is effective in reducing the incidences of AF and pericardial effusion in patients undergoing isolated CABG. Despite the positive outcomes, the presence of heterogeneity and publication bias warrants a cautious interpretation of the results and underscores the need for further multicentre RCTs in this area.
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Affiliation(s)
- Taw Moe Myat San
- Department of Surgery, Pyin Oo Lwin General Hospital, University of Medicine Mandalay, Myanmar
| | | | - Muhammad Ismail
- Department of Neurosurgery, Khalifa Gul Nawaz Hospital, Medical Teaching Institution, Bannu, Pakistan
| | - Lei Myint Thu
- Department of Trauma & Orthopaedic, Colchester General Hospital, Colchester, United Kingdom
| | - Myat Soe Thet
- Department of Surgery and Cancer, Imperial College London, United Kingdom.
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Soletti GJ, Perezgrovas-Olaria R, Harik L, Rahouma M, Dimagli A, Alzghari T, Demetres M, Bratton BA, Yaghmour M, Satija D, Lau C, Girardi LN, Salemo TA, Gaudino M. Effect of posterior pericardiotomy in cardiac surgery: A systematic review and meta-analysis of randomized controlled trials. Front Cardiovasc Med 2022; 9:1090102. [PMID: 36620644 PMCID: PMC9816139 DOI: 10.3389/fcvm.2022.1090102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 12/02/2022] [Indexed: 12/24/2022] Open
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.
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Affiliation(s)
- Giovanni Jr Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | | | - Lamia Harik
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Mohamed Rahouma
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Arnaldo Dimagli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Talal Alzghari
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Michelle Demetres
- Samuel J. Wood Library and C.V. Starr Biomedical Information Center, Weill Cornell Medicine, New York, NY, United States
| | - Brenden A. Bratton
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Mohammad Yaghmour
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Divyaam Satija
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Christopher Lau
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Leonard N. Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
| | - Tomas A. Salemo
- Division of Cardiothoracic Surgery, University of Miami Miller School of Medicine and Jackson Memorial Hospital, Miami, FL, United States
| | - Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, NY, United States
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Rego A, Cheung PC, Harris WJ, Brady KM, Newman J, Still R. Pericardial closure with extracellular matrix scaffold following cardiac surgery associated with a reduction of postoperative complications and 30-day hospital readmissions. J Cardiothorac Surg 2019; 14:61. [PMID: 30876459 PMCID: PMC6419853 DOI: 10.1186/s13019-019-0871-5] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Accepted: 02/17/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND A prospective, multi-center study (RECON) was conducted to evaluate the clinical outcomes of pericardial closure using a decellularized extracellular matrix (ECM) graft derived from porcine small intestinal submucosa. METHODS Patients indicated for open cardiac surgery with pericardial closure using ECM were eligible for the RECON study cohort. Postoperative complications and readmission of the RECON patients were compared to the patient cohort in the Nationwide Readmissions Database (NRD). Inverse probability of treatment weighting was used to control the differences in patient demographics, comorbidities, and risk factors. RESULTS A total of 1420 patients at 42 centers were enrolled, including 923 coronary artery bypass grafting (CABG) surgeries and 436 valve surgeries. Significantly fewer valve surgery patients in the RECON cohort experienced pleural effusion (3.1% vs. 13.0%; p < 0.05) and pericardial effusion (1.5% vs. 2.6%; p < 0.05) than in the NRD cohort. CABG patients in the RECON cohort were less likely to suffer bleeding (1.2% vs. 2.9%; p < 0.05) and pericardial effusion (0.2% vs. 2.2%, p < 0.05) than those in the NRD cohort. The 30-day all-cause hospital readmission rate was significantly lower among RECON patients than NRD patients following both valve surgery (HR: 0.34; p < 0.05) and CABG surgery (HR: 0.42; p < 0.05). In the RECON study, 14.4% of CABG patients and 27.0% of valve patients had postoperative atrial fibrillation as compared to previously reported risks, which generally ranges from 20 to 30% after CABG and from 35 to 50% after valve surgery. CONCLUSIONS Pericardial closure with ECM following cardiac surgery is associated with a reduction in the proportion of patients with pleural effusion, pericardial effusion, and 30-day readmission compared to a nationwide database. TRIAL REGISTRATION NCT02073331 , Registered on February 27, 2014.
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Affiliation(s)
- Alfredo Rego
- South Florida Heart & Lung Institute, 3650 NW 82nd Ave, Doral, FL 33166 USA
| | - Patricia C. Cheung
- Department of Epidemiology, Emory University Rollins School of Public Health, Atlanta, GA USA
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