Effect of posterior pericardiotomy on atrial fibrillation in minimally invasive direct coronary artery bypass surgery.

objectivePosterior pericardiotomy can be performed after cardiac surgery to drain pericardial fluid and reduce the incidence of postoperative atrial fibrillation. However, the effect of posterior pericardiotomy in minimally invasive direct coronary artery bypass surgery on the development of postoperative atrial fibrillation remains unknown.

methodsThe patients included in our study underwent complete revascularization through left anterior thoracotomy under cardiopulmonary bypass, using X-clamp and cardioplegia, without any limitations on coronary lesion type or localization. Patients who underwent minimally invasive direct coronary artery bypass were retrospectively divided into two groups: the control group, consisting of patients who did not undergo posterior pericardiotomy, and the posterior pericardiotomy group, consisting of patients who underwent posterior pericardiotomy after this date. The two groups were retrospectively compared in terms of postoperative atrial fibrillation development, the day of left thoracic drain removal, and clinical characteristics.

resultsLower development of atrial fibrillation was observed in the posterior pericardiotomy group (n = 10, 13.3%) compared to the control group (n = 20, 30.3%) (p = 0.024). When comparing the days of drain removal, the left thoracic drain was removed later in the patients in the posterior pericardiotomy group compared to the control group (3.2 ± 1.18, 2.6 ± 0.96, p = 0.007). There was no difference between the groups in terms of patient characteristics compared (p > 0.05).

conclusionIn this revascularization technique, where the left-sided pericardiotomy is partially closed to prevent cardiac herniation, posterior pericardiotomy may help prevent the development of postoperative atrial fibrillation by facilitating the drainage of pericardial fluid.