Department of Cardiovascular Surgery, The Second Affiliated Hospital, Zhejiang University School of Medicine, Hangzhou, People's Republic of China.
Department of Biomedical Research, Research and Innovation Center, Xinjiang Institute of Technology, Xinjiang, People's Republic of China.
Braz J Cardiovasc Surg. 2023 Aug 4;38(5):e20220350. doi: 10.21470/1678-9741-2022-0350.
Postoperative atrial fibrillation (POAF) and pericardial effusion are important factors affecting prognosis after cardiac surgery. Recently, it has been reported that posterior pericardiotomy (PP) can effectively prevent the occurrence of POAF and pericardial effusion. To validate these conclusions and guide clinical practice, we conducted a systematic review with meta-analysis.
We searched multiple databases for manuscripts published before July 2022 on the use of PP to prevent POAF and pericardial effusion and included only randomized controlled trials. The main outcome was atrial fibrillation after coronary artery bypass grafting, and secondary outcomes were included.
This meta-analysis included 14 randomized controlled trials with a total of 2275 patients. Meta-analysis showed that the incidence of POAF after cardiac surgery in the PP group was significantly lower than that in the control group (risk ratio=0.48; 95% confidence interval=0.33~0.69; P<0.00001). PP effectively reduced postoperative pericardial effusion (risk ratio=0.34, 95% confidence interval=0.21-0.55; P<0.00001).
PP has shown good results in preventing POAF, pericardial effusion, and other complications, which indicates that PP is a safe and effective surgical method, but attention still needs to be paid to the potential risk of coagulation dysfunction caused by PP.
术后心房颤动（POAF）和心包积液是影响心脏手术后预后的重要因素。最近有报道称，心包切开术（PP）可有效预防 POAF 和心包积液的发生。为了验证这些结论并指导临床实践，我们进行了系统评价和荟萃分析。
我们检索了多个数据库，以获取截至 2022 年 7 月发表的关于使用 PP 预防 POAF 和心包积液的文献，并仅纳入随机对照试验。主要结局是冠状动脉旁路移植术后心房颤动，包括次要结局。
本荟萃分析纳入了 14 项随机对照试验，共 2275 例患者。荟萃分析显示，PP 组心脏手术后 POAF 的发生率明显低于对照组（风险比=0.48；95%置信区间=0.330.69；P<0.00001）。PP 有效减少术后心包积液（风险比=0.34，95%置信区间=0.210.55；P<0.00001）。
PP 在预防 POAF、心包积液和其他并发症方面显示出良好的效果，这表明 PP 是一种安全有效的手术方法，但仍需注意 PP 引起的凝血功能障碍的潜在风险。
