Posterior left pericardiotomy: what is the advantage in cardiac surgery?

Overview

OBJECTIVES: Postoperative atrial fibrillation (POAF) is the most common complication following cardiac surgery and is associated with prolonged in-hospital stay and increased costs, morbidity (including stroke and heart failure) and mortality. Posterior pericardiotomy (PP) is a surgical intervention aimed at draining the pericardium into the left pleural cavity to reduce POAF occurrence. This review summarizes the current evidence on the use of PP and highlights future perspectives for clinical research. METHODS: The present work is a narrative review, a systematic literature search was therefore not performed. After collegial discussion, the most relevant papers as per the authors' opinion were selected and formed the basis of the present review. RESULTS: Several studies support the hypothesis that PP decreases the incidence of POAF, pericardial effusion and cardiac tamponade after cardiac surgery. Although an increased incidence of pleural effusion has been reported after PP, this finding does not translate into increased pulmonary complications. Whether the systematic use of PP during cardiac surgery improves long-term outcomes is unclear. CONCLUSIONS: PP is a simple and safe technique that holds the potential to positively impact cardiac surgical patients' postoperative course. The results of upcoming, multicentre trials will help shed definitive light on this topic.