ArticleAmerican heart journal2023
Postoperative pericardial effusion, pericardiotomy, and atrial fibrillation: An explanatory analysis of the PALACS trial.
Article in American heart journal, 2023. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 10 papers, 1 of them a synthesis that pooled it.
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The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
The trial behind it
Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
10 citing papers in PubMed, 1 synthesis or guideline pooled it, 14 citations in OpenAlex.
- Comparison of perioperative outcomes of minimally invasive and conventional aortic root surgery in adult patients: a systematic review and meta-analysis.General thoracic and cardiovascular surgery · 2026Pooled it
- Baseline Intraoperative Left Ventricular Diastolic Function Is Associated with Postoperative Atrial Fibrillation after Cardiac Surgery.Anesthesiology · 2023Trial
- Effect of posterior pericardiotomy on atrial fibrillation in minimally invasive direct coronary artery bypass surgery.General thoracic and cardiovascular surgery · 2026Article
- Efficacy of Jackson-Pratt Mediastinal Drains in Reducing Pericardial Effusion and Atrial Fibrillation After Coronary Artery Bypass Grafting: A Retrospective Cohort Study.Brazilian journal of cardiovascular surgery · 2026Article
- Risks and Prognostic Implications of Pericardial Disease and Atrial Fibrillation after Cardiac Surgery.Current cardiology reports · 2025Review
- Surgical Methods and Devices for Atrial Fibrillation.Reviews in cardiovascular medicine · 2025Review
- Posterior left pericardiotomy: what is the advantage in cardiac surgery?European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Review
- The impact of a chest drainage system on retained blood-associated complications after cardiac surgery.European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery · 2025Article
- Skin mottling score assesses peripheral tissue hypoperfusion in critically ill patients following cardiac surgery.BMC anesthesiology · 2024Article
- Posterior cardiac drain for atrial fibrillation after aortic valve replacement.SAGE open medicine · 2024Article
Corrections and comments
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Authors and funding
18 authors at 6 institutions in 5 countries.
Funding
Abstract
backgroundIn the Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery (PALACS) trial, posterior pericardiotomy was associated with a significant reduction in postoperative atrial fibrillation (POAF) after cardiac surgery. We aimed to investigate the mechanisms underlying this effect.
methodsWe included PALACS patients with available echocardiographic data (n = 387/420, 92%). We tested the hypotheses that the reduction in POAF with the intervention was associated with 1) a reduction in postoperative pericardial effusion and/or 2) an effect on left atrial size and function. Spline and multivariable logistic regression analyses were used.
resultsMost patients (n = 307, 79%) had postoperative pericardial effusions (anterior 68%, postero-lateral 51.9%). The incidence of postero-lateral effusion was significantly lower in patients undergoing pericardiotomy (37% vs 67%; P < .001). The median size of anterior effusion was comparable between patients with and without POAF (5.0 [IQR 3.0-7.0] vs 5.0 [IQR 3.0-7.5] mm; P = .42), but there was a nonsignificant trend towards larger postero-lateral effusion in the POAF group (5.0 [IQR 3.0-9.0] vs 4.0 [IQR 3.0-6.4] mm; P = .06). There was a non-linear association between postero-lateral effusion and POAF at a cut-off at 10 mm (OR 2.70; 95% CI 1.13, 6.47; P = .03) that was confirmed in multivariable analysis (OR 3.5, 95% CI 1.17, 10.58; P = 0.02). Left atrial dimension and function did not change significantly after posterior pericardiotomy.
conclusionsReduction in postero-lateral pericardial effusion is a plausible mechanism for the effect of posterior pericardiotomy in reducing POAF. Measures to reduce postoperative pericardial effusion are a promising approach to prevent POAF.
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