Posterior Pericardiotomy: Historical Perspective, Current Techniques, and Clinical Outcomes.

Background: Cardiac tamponade and postoperative atrial fibrillation remain significant challenges after cardiac surgery, contributing to higher morbidity, mortality, and health care costs. Posterior pericardiotomy (PP) has been used to reduce these complications. This review summarizes the history, technique, and clinical evidence for PP. Methods: We identified recent studies related to PP to perform a narrative overview of its indications, techniques, and clinical outcomes. This was supplemented with historical context from cardiac surgeons who were early adopters of the procedure. Results: Evidence demonstrates that PP reduces postoperative pericardial effusion, tamponade, and postoperative atrial fibrillation by improving pericardial drainage, preventing tamponade, and secondarily decreasing pericardial inflammation and oxidative stress. Conclusions: Despite receiving a class 2a recommendation in recent American College of Cardiology guidelines for atrial fibrillation prevention, PP is not widely performed. Given its simplicity, safety, and effectiveness, wider use of PP could improve outcomes after cardiac surgery.