Ranjan Redoy, Kapetanakis Stamatis, Chandrasekaran Venkatachalam, Kaba Riyaz A, Momin Aziz U
Department of Cardiac Surgery, St George's University Hospitals NHS Foundation Trust, London, UK.
Department of Cardiac Surgery, Bangabandhu Sheikh Mujib Medical University, Dhaka, Bangladesh.
Ther Clin Risk Manag. 2025 Apr 15;21:481-487. doi: 10.2147/TCRM.S521874. eCollection 2025.
Postoperative new atrial fibrillation (POAF) commonly occurs after coronary artery bypass graft (CABG) and is often associated with postoperative pericardial effusion. We aimed to investigate the effectiveness of a posterior pericardial window (PPW) with a single left pleural drain in reducing post-CABG pericardial effusion and atrial fibrillation without mediastinal chest drains.
This descriptive observational study evaluated age and sex-adjusted isolated elective on-pump CABG patients into two groups: PPW with only left pleural chest drains and control (routine multiple mediastinal and pleural chest drains. We performed continuous telemonitoring for 96 hours after surgery to assess heart rhythm, followed by daily electrocardiograms. Bedside echocardiography was conducted on postoperative day 4 to check for pericardial effusion.
This study evaluated age and sex-adjusted 250 CABG patients, with male predominance (80%) and identical comorbidities between study groups. We found similar age (61.5 ±7.5 vs 62.6 ±6.2, P =0.40) and male sex (86.9% vs 74.8%, P =0.13) between the PPW and control groups. Additionally, the sociodemographic and intraoperative variables were the same across the study groups (P >0.05). The occurrence of >1cm pericardial effusions (0.8% vs 14.1%, P <0.001) and postoperative AF (6.9% vs 19.3%, P =0.002) occurrence was significantly lower in the PPW compared to the control group.
Despite similar clinical and operative profiles, a posterior pericardial window with a single left pleural drain effectively reduces pericardial effusion and the incidence of postoperative AF following CABG surgery.
冠状动脉旁路移植术（CABG）后常发生术后新发房颤（POAF），且常与术后心包积液相关。我们旨在研究后心包开窗术（PPW）联合单根左侧胸腔引流管在不使用纵隔胸腔引流管的情况下减少CABG术后心包积液和房颤的有效性。
这项描述性观察性研究将年龄和性别调整后的择期体外循环CABG患者分为两组：仅行左侧胸腔引流管的PPW组和对照组（常规多根纵隔和胸腔引流管）。术后持续进行96小时的远程监测以评估心律，随后每日进行心电图检查。术后第4天进行床边超声心动图检查以检查心包积液情况。
本研究评估了年龄和性别调整后的250例CABG患者，男性占优势（80%），研究组之间合并症相同。我们发现PPW组和对照组之间年龄相似（61.5±7.5 vs 62.6±6.2，P = 0.40），男性比例相似（86.9% vs 74.8%，P = 0.13）。此外，研究组之间的社会人口统计学和术中变量相同（P>0.05）。与对照组相比，PPW组中>1cm心包积液的发生率（0.8% vs 14.1%，P<0.001）和术后房颤的发生率（6.9% vs 19.3%，P = 0.002）显著更低。
尽管临床和手术情况相似，但后心包开窗术联合单根左侧胸腔引流管可有效减少CABG术后的心包积液和房颤发生率。
