Sahdev Nikhil, Liu Guiqing, Hasanzade Sahar, Nagi Jasleen, Taghavi Azar Sharabiani Mansour, Punjabi Prakash
Department of Cardiothoracic Surgery, Hammersmith Hospital, Imperial College Healthcare NHS Trust, London, United Kingdom.
Imperial College School of Public Health, White City Campus, London, United Kingdom.
JTCVS Open. 2025 May 3;25:120-125. doi: 10.1016/j.xjon.2025.04.006. eCollection 2025 Jun.
Atrial fibrillation (AF) is a common postoperative complication with an incidence of up to 10% to 33% after coronary artery bypass grafting surgery and is associated with worse morbidity and mortality. At present, studies have shown a promising reduction in postoperative AF (POAF) with posterior pericardiotomy (PP). However, there are limited data on the widespread use of PP amongst cardiac surgeons. This retrospective analysis assesses the influence of a real-world adoption of PP on the incidence and cumulative burden of POAF.
Patients who underwent coronary artery bypass grafting surgery between 2015 and 2022 were analyzed. One group had PP as part of their surgical procedure whilst the control group did not. For both groups, the incidence of POAF was analyzed. PP was performed via a 5-cm incision between the left inferior pulmonary vein and the phrenic nerve.
Two thousand four hundred eighty patients were included in the analysis; 806 patients underwent PP and 1674 formed the control group. PP was associated with a 27.4% reduction in the odds of developing POAF (odds ratio, 0.73; 95% CI, 0.55-0.95; = .023). Age was significantly associated with POAF, with a 4.3% increase in odds per additional year (odds ratio, 1.04; 95% CI, 1.03-1.06; < .001). In the multivariate model for AF, PP remained significantly protective, reducing the odds of POAF by 26.9% (odds ratio, 0.73; 95% CI, 0.55-0.96; = .028). Patients who underwent PP had significantly reduced cumulative POAF duration, with a 5.3% average reduction ( = .002).
Posterior left pericardiotomy is associated with reduced odds and duration of POAF. A large, multicenter trial is indicated to confirm this finding as well as the influence of PP and POAF on postdischarge clinical outcomes.
心房颤动（AF）是一种常见的术后并发症，在冠状动脉旁路移植术后的发生率高达10%至33%，且与更高的发病率和死亡率相关。目前，研究表明后心包切开术（PP）能显著降低术后房颤（POAF）的发生率。然而，关于心脏外科医生广泛使用PP的数据有限。本回顾性分析评估了在现实世界中采用PP对POAF发生率和累积负担的影响。
对2015年至2022年间接受冠状动脉旁路移植术的患者进行分析。一组患者在手术过程中进行了PP，而对照组未进行。分析两组患者的POAF发生率。PP通过在左下肺静脉和膈神经之间做一个5厘米的切口进行。
2480例患者纳入分析；806例患者接受了PP，1674例组成对照组。PP与POAF发生几率降低27.4%相关（优势比，0.73；95%可信区间，0.55 - 0.95；P = 0.023）。年龄与POAF显著相关，每增加一岁发生几率增加4.3%（优势比，1.04；95%可信区间，1.03 - 1.06；P < 0.001）。在房颤多变量模型中，PP仍具有显著保护作用，使POAF发生几率降低26.9%（优势比，0.73；95%可信区间，0.55 - 0.96；P = 0.028）。接受PP的患者POAF累积持续时间显著缩短，平均缩短5.3%（P = 0.002）。
左后心包切开术与POAF发生几率和持续时间降低相关。需要进行一项大型多中心试验来证实这一发现以及PP和POAF对出院后临床结局的影响。
