Posterior pericardiotomy in patients undergoing CABG in prevention of post operative Atrial fibrilla
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Posterior Pericardiotomy in Preventing Postoperative Atrial Fibrillation After CABG
Introduction to Posterior Pericardiotomy and CABG
Posterior pericardiotomy (PP) is a surgical technique used to reduce the incidence of postoperative complications, particularly atrial fibrillation (AF), following coronary artery bypass grafting (CABG). AF is a common and serious complication after cardiac surgery, leading to increased morbidity, prolonged hospital stays, and higher healthcare costs .
Efficacy of Posterior Pericardiotomy in Reducing Atrial Fibrillation
Meta-Analyses and Randomized Controlled Trials
Several meta-analyses and randomized controlled trials (RCTs) have demonstrated the efficacy of PP in reducing the incidence of postoperative AF in patients undergoing CABG. A meta-analysis of ten RCTs involving 1,648 patients found that the incidence of AF was significantly lower in the PP group (10.6%) compared to the control group (24.9%). Another comprehensive review of 25 RCTs with 4,467 patients reported a similar reduction in AF incidence, with 11.7% in the PP group versus 23.67% in the control group.
Consistent Findings Across Studies
The findings are consistent across various studies. For instance, a meta-analysis of six prospective, randomized studies involving 763 patients showed a significant reduction in AF incidence in the PP group (10.8%) compared to the control group (28.1%). Another study with 1829 patients also confirmed that PP significantly lowers the risk of AF post-CABG (10.3% in the PP group vs. 25.7% in the control group).
Mechanism: Reduction of Pericardial Effusion
Role of Pericardial Effusion in AF
Pericardial effusion is a known risk factor for AF after cardiac surgery. PP helps in draining the pericardial space, thereby reducing the incidence of pericardial effusion, which in turn lowers the risk of AF . Studies have shown that patients with pericardial effusion are more likely to develop AF, and PP effectively reduces both early and late pericardial effusion .
Supporting Evidence
A study involving 100 patients undergoing elective CABG found that early pericardial effusion developed in only 12% of the PP group compared to 42% in the control group, with a corresponding reduction in AF incidence (10% vs. 30%). Another study with 425 patients reported a significant decrease in both early and late pericardial effusion and AF in the PP group.
Economic and Clinical Benefits
Reduced Hospital Stay and Costs
PP not only reduces the incidence of AF and pericardial effusion but also has economic benefits. It decreases the length of hospital and intensive care unit (ICU) stays, leading to lower overall hospital costs . For example, a study highlighted that the total hospital costs were lower in the PP group due to shorter hospital stays and fewer complications.
Safety and Complications
While PP is generally safe, it is associated with a higher incidence of pleural effusion. However, this does not significantly impact the overall pulmonary complications or operative mortality . The benefits of reduced AF and pericardial effusion outweigh the risks associated with pleural effusion.
Conclusion
Posterior pericardiotomy is a safe and effective technique for reducing the incidence of postoperative atrial fibrillation and pericardial effusion in patients undergoing coronary artery bypass grafting. The consistent findings across multiple studies and meta-analyses support its use in clinical practice to improve patient outcomes and reduce healthcare costs. Further high-quality RCTs are warranted to confirm these findings and optimize the surgical approach.
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