Posterior pericardiotomy in cardiac surgery: Collaboration with England and Germany

This systematic review with meta-analysis sought to determine the impact of posterior pericardiotomy on incidences of atrial fibrillation and supraventricular arrhythmias, pericardial effusion, pleural effusion, tamponade, and the length of hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with ۹۵% confidence interval for calculating differences between mean values of hospital stay in intervention and control groups. A value of p < ۰.۱ for Q test or I۲ >  ۵۰% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved ۲۰ studies. After screening, ۱۲ suitable trials were identified, which reported outcomes of ۲۰۵۲ patients undergoing cardiac surgery. Posterior pericardiotomy had an odds ratio of ۰.۳۳ [۹۵% confidence interval: ۰.۱۸-۰.۶۱] p < ۰.۰۰۱ for atrial fibrillation; odds ratio ۰.۳۲ [۰.۱۵-۰.۶۷] p = ۰.۰۰۳ for supraventricular arrhythmias; odds ratio ۰.۰۹ [۰.۰۴-۰.۱۹] p = ۰.۰۰۰ for early pericardial effusion and odds ratio ۰.۰۴ [۰.۰۲-۰.۰۸] p < ۰.۰۰۱ for late pericardial effusion; odds ratio ۱.۶۴ [۱.۲۳-۲.۲۰] p = ۰.۰۰۱ for pleural effusion, odds ratio ۰.۰۷ [۰.۰۲-۰.۲۷] p < ۰.۰۰۱ for tamponade, and standard mean difference = ۰.۰۱ [-۰.۱۲ to ۰.۱۴] p = ۰.۸ for hospital stay. Posterior pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of pleural effusion associated with posterior pericardiotomy might be higher