Karic Alen, Mujaric Ekrema, Krajnovic Alma, Busevac Ervin, Selimovic Tarik, Milaimi Amar, Sljivo Armin
Clinic for Cardiovascular Diseases, Clinical Center of University of Sarajevo.
Departmen of Internal Medicine, Cantonal Hospital Zenica.
Mater Sociomed. 2025;37(2):159-163. doi: 10.5455/msm.2025.37.159-163.
Posterior pericardiotomy has been proposed as a preventive strategy against postoperative pericardial effusion and cardiac tamponade in patients undergoing coronary artery bypass grafting (CABG). However, data regarding its clinical outcomes and potential associations with postoperative complications remain limited.
To evaluate intraoperative and postoperative outcomes in patients undergoing off-pump CABG with concomitant posterior pericardiotomy, and to assess potential associations between perioperative variables and the development of common postoperative complications.
This retrospective study included 38 patients who underwent off-pump CABG with posterior pericardiotomy. Demographic and clinical characteristics, procedural details, postoperative complications, and outcomes were analyzed. Associations between operative time, comorbidities (sex, diabetes mellitus, smoking), and postoperative complications such as atrial fibrillation, pleural and pericardial effusions, and drainage volume were statistically evaluated using chi-square and correlation analysis.
The study cohort had a mean age of 66.64 ± 7.28 years, with 68.1% male patients. Arterial hypertension was present in all patients, diabetes mellitus in 44.7%, and prior myocardial infarction in 65.7%. The mean left ventricular ejection fraction was 42.86 ± 10.21%, and triple-vessel disease was observed in 63.2% of patients. All patients underwent off-pump CABG. The mean operative time was 254.31 ± 59.04 minutes. Postoperative complications included new-onset atrial fibrillation in 15.7% of patients, pleural effusion in 42.1%, and pericardial effusion in 10.5%. No cases of cardiac tamponade were reported. A significant association was found between smoking and new-onset atrial fibrillation (p = 0.050), while no significant associations were observed between sex or diabetes and postoperative complications. Operative time was not significantly associated with pericardial or pleural effusion, nor with drainage volume. Complete recovery was observed in all 100.0% of patients.
Posterior pericardiotomy performed during off-pump CABG was associated with a low incidence of pericardial effusion and no occurrence of cardiac tamponade. The procedure appears to be safe and may contribute to favorable postoperative outcomes. Smoking may be a risk factor for new-onset atrial fibrillation, warranting further investigation.
心包后切开术已被提议作为冠状动脉旁路移植术（CABG）患者预防术后心包积液和心脏压塞的一种策略。然而，关于其临床结果以及与术后并发症潜在关联的数据仍然有限。
评估接受非体外循环CABG并同期行心包后切开术患者的术中及术后结果，并评估围手术期变量与常见术后并发症发生之间的潜在关联。
这项回顾性研究纳入了38例行非体外循环CABG并心包后切开术的患者。分析了人口统计学和临床特征、手术细节、术后并发症及结果。使用卡方检验和相关性分析对手术时间、合并症（性别、糖尿病、吸烟）与术后并发症（如房颤、胸腔和心包积液以及引流量）之间的关联进行统计学评估。
研究队列的平均年龄为66.64±7.28岁，男性患者占68.1%。所有患者均患有动脉高血压，44.7%患有糖尿病，65.7%有既往心肌梗死病史。平均左心室射血分数为42.86±10.21%，63.2%的患者观察到三支血管病变。所有患者均接受了非体外循环CABG。平均手术时间为254.31±59.04分钟。术后并发症包括15.7%的患者出现新发房颤，42.1%出现胸腔积液，10.5%出现心包积液。未报告心脏压塞病例。发现吸烟与新发房颤之间存在显著关联（p = 0.050），而未观察到性别或糖尿病与术后并发症之间存在显著关联。手术时间与心包或胸腔积液以及引流量均无显著关联。所有患者（100.0%）均实现完全康复。
非体外循环CABG期间进行的心包后切开术与心包积液发生率低且无心脏压塞发生相关。该手术似乎是安全的，可能有助于获得良好的术后结果。吸烟可能是新发房颤的一个危险因素，值得进一步研究。
