Abstract
BackgroundAtrial fibrillation (AF) is associated with adverse events after cardiac surgery. Multiple studies have reported that posterior pericardiotomy (PP) may be effective for preventing AF after coronary artery bypass grafting (CABG), but some conflicting results have been reported and the quality of evidence from previous meta-analyses has been limited. The present study aimed to systematically evaluate the safety and efficacy of PP for preventing AF after CABG in adults.MethodsWe conducted a quantitative meta-analysis of randomized controlled trials (RCTs) published before May 31, 2021. The primary outcome was AF after CABG under cardiopulmonary bypass. Secondary outcomes included early pericardial effusion, late pericardial effusion, pericardial tamponade, pleural effusion, length of hospital stay, length of intensive care unit (ICU) stay, pulmonary complications, intra-aortic balloon pump use, revision surgery for bleeding, and mortality.ResultsTen RCTs with 1829 patients (910 in the PP group and 919 in the control group) were included in the current meta-analysis. The incidence of AF was 10.3% (94/910) in the PP group and 25.7% (236/919) in the control group. A random-effects model indicated that incidence of AF after CABG significantly lower in the PP group than in the control group (risk ratio = 0.45, 95% confidence interval 0.29–0.64, P < 0.0001). PP also effectively reduced the post-CABG occurrence of early pericardial effusion (RR = 0.28, 95% CI 0.15–0.50; P < 0.05), late pericardial effusion (RR = 0.06, 95% CI 0.02–0.16; P < 0.05), and pericardial tamponade (RR = 0.08, 95% CI 0.02–0.33; P < 0.05) as well as the length of ICU stay (weighted mean difference [WMD] = 0.91,95% CI 0.57–1.24; P < 0.05), while increasing the occurrence pleural effusion (RR = 1.51, 95% CI 1.19–1.92; P < 0.05). No significant differences length of hospital stay (WMD = − 0.45, 95% CI − 2.44 to 1.54, P = 0.66), pulmonary complications (RR = 0.99, 95% CI 0.71–1.39, P = 0.97), revision surgery for bleeding (RR = 0.84, 95% CI 0.43–1.63, P = 0.60), use of IABP (RR = 1, 95% CI 0.61–1.65, P = 1.0), or death (RR = 0.45, 95% CI 0.07–3.03, P = 0.41) were observed between the PP and control groups.ConclusionsPP may be a safe, effective, and economical method for preventing AF after CABG in adult patients.
Highlights
Atrial fibrillation (AF) is associated with adverse events after cardiac surgery
Trial characteristics The characteristics of the 10 included randomized controlled trial (RCT) and their participants are presented in Table 2, and the data reported by each included trial are described in Additional file 2: Table S1, and the actual mode of posterior pericardiotomy (PP) and the use of posterior pericardial drains are described in Additional file 2: Table S2
According to the Grades of Recommendations Assessment Development and Evaluation (GRADE) system, the strength of evidence was high for pericardial tamponade, pleural effusion, and early pericardial effusion; moderate for AF, intensive care unit (ICU) stay, and late pericardial effusion; low for pulmonary complications; and extremely low for revision surgery for bleeding, intra-aortic balloon pump (IABP) use, hospital stay, and death
Summary
Multiple studies have reported that posterior pericardiotomy (PP) may be effective for preventing AF after coronary artery bypass grafting (CABG), but some conflicting results have been reported and the quality of evidence from previous meta-analyses has been limited. Based on previous studies demonstrating a clear relationship between pericardial effusion and supra-ventricular arrhythmias, Mulay et al [17] invented the technique of posterior pericardiotomy (PP). Multiple studies have confirmed that PP is a promising, economical, and effective technique for preventing POAF after cardiac surgery [17,18,19,20], because it can drain pericardial effusion to the left pleural cavity, which should reduce the risk of AF. In order to evaluate more comprehensively the effectiveness of PP for preventing POAF, we conducted the present metaanalysis of a randomized trials to systematically evaluate the safety and effectiveness of PP for preventing AF after CABG in adults
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