Hamiko Marwan, Spaeth Andre, Alirezaei Hossien, Krasivskyi Ihor, Rogaczewski Julia, Silaschi Miriam, Kruse Jacqueline, Salamate Saad, Ahmad Ali El-Sayed, Bakhtiary Farhad
Department of Cardiac Surgery, University Heart Center Bonn, Bonn, Germany.
Interdiscip Cardiovasc Thorac Surg. 2025 May 6;40(5). doi: 10.1093/icvts/ivaf105.
Re-thoracotomy due to pericardial effusion is a frequent complication after aortic surgery, leading to prolonged intensive care unit (ICU) and hospital stays and adverse outcomes. This study aims to evaluate the frequency of re-thoracotomy and postoperative atrial fibrillation in patients undergoing ascending aorta replacement with or without posterior left pericardiotomy.
We retrospectively analysed clinical data from patients who underwent elective ascending aorta replacement with or without aortic root between January 2014 and June 2024. Patients were divided into two groups based on posterior left pericardiotomy. We assessed re-thoracotomy due to bleeding or pericardial effusion, postoperative atrial fibrillation, ICU and in-hospital stay, as well as mortality rates, adjusting for confounders using propensity score matching.
A total of 256 patients could be included (n = 140 without and n = 116 with posterior left pericardiotomy). Mean age was 61.6 ±12.2 years, with 27.7% female patients. After matching, re-thoracotomy (12.9% vs 3.4%; P = 0.007) and postoperative atrial fibrillation (36.4% vs 16.4%; P = 0.011) were higher in patients without pericardiotomy. Thirty-day and 1-year mortality were 1.3% and 4.2%, respectively. Posterior left pericardiotomy was associated with shorter ventilation time (8.0 vs 15.0 hours; P < 0.001) and hospital stay (8.0 vs 12.0 days; P < 0.001). Similar results were observed between the unmatched and the matched cohort.
Posterior left pericardiotomy is a simple surgical manoeuvre associated with lower rates of re-thoracotomy and postoperative atrial fibrillation in elective aortic surgery patients in a retrospective cohort. Further prospective randomized trials should be performed to confirm and highlight the results from our study.
因心包积液而再次开胸手术是主动脉手术后常见的并发症，会导致重症监护病房（ICU）和住院时间延长以及不良后果。本研究旨在评估在进行升主动脉置换术时，无论是否进行左后心包切开术的患者中再次开胸手术和术后房颤的发生率。
我们回顾性分析了2014年1月至2024年6月期间接受择期升主动脉置换术（无论是否进行主动脉根部手术）患者的临床数据。根据是否进行左后心包切开术将患者分为两组。我们评估了因出血或心包积液导致的再次开胸手术、术后房颤、ICU住院时间和住院时间，以及死亡率，并使用倾向评分匹配法对混杂因素进行了调整。
总共纳入了256例患者（未进行左后心包切开术的患者n = 140例，进行左后心包切开术的患者n = 116例）。平均年龄为61.6±12.2岁，女性患者占27.7%。匹配后，未进行心包切开术的患者再次开胸手术（12.9%对3.4%；P = 0.007）和术后房颤（36.4%对16.4%；P = 0.011）的发生率更高。30天和1年死亡率分别为1.3%和4.2%。左后心包切开术与较短的通气时间（8.0小时对15.0小时；P < 0.001）和住院时间（8.0天对12.0天；P < 0.001）相关。在未匹配和匹配队列中观察到了类似的结果。
在一项回顾性队列研究中，左后心包切开术是一种简单的手术操作，与择期主动脉手术患者较低的再次开胸手术率和术后房颤发生率相关。应进行进一步的前瞻性随机试验以证实并突出我们研究的结果。
