Should the pericardium be closed routinely after heart operations?

Abstract

Background. Repeat coronary artery bypass grafting is more difficult if the right ventricle is firmly attached to the inner table of the sternum. Closure of the pericardium at the time of the initial procedure may prevent attachment of the right ventricle to the sternum. This study attempts to identify the geometric effects of pericardial closure early after isolated coronary artery bypass grafting. Methods. Forty-two patients undergoing elective, isolated coronary artery bypass grafting were randomized into two groups: 20 patients underwent closure of the pericardium (Closure group) and the pericardium was left open in 22 patients (Open group). Radiopaque markers were attached to the anterior aspect of the right ventricular epicardium in both groups. Results. Postoperative chest roentgenograms revealed that the distance between the epicardial surface and the posterior table of the sternum was larger in the Closure group compared to the Open group at 1 week and 3 months postoperatively ( p < 0.001). Cardiac index and stroke work index in the early postoperative period was lower in the Closure group compared to the Open group ( p < 0.001) despite similar filling pressures. Conclusions. Pericardial closure may reduce the risk of myocardial injury during sternotomy for repeat coronary artery bypass grafting by preventing right ventricular adhesions. However, adverse hemodynamic effects in the early postoperative period may preclude pericardial closure in patients with impaired ventricular function.