Right Pleuro-Pericardial Window during Cardiac Surgery: A Safe and Simple Technique that Decreases Postoperative Atrial Fibrillation.

Purpose: Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery and is associated with increased hospital stay, morbidity, and mortality. One of the major factors predisposing patients to the development of POAF is inflammation related to pericardial effusions, which may occur after cardiac surgery. We hypothesized that by creating a pleuro-pericardial window before closing the chest during cardiac surgery, draining the pericardial space into the right pleural space may lead to fewer pericardial effusions and less postoperative atrial fibrillation.

Methods: We conducted a study that included 172 consecutive patients (67 ± 12 years, 48.3% female) who underwent cardiac surgery (73.8% aortic valve replacement [AVR], 5.8% mitral valve replacement, 19% AVR + coronary artery bypass grafting). The first 95 patients included in this study (67 ± 12 years, 48% female) did not have any pleuro-pericardial window created, whereas the remaining 77 patients (67 ± 12 years, 48% female) did. Baseline clinical and procedural characteristics were compared between the 2 groups. Postoperative events and complications were collected until hospital discharge.

Results: A total of 50 patients developed POAF (29%). The incidence of POAF among patients who underwent a pleuro-pericardial window was 18.2% (95% confidence interval [CI]: 9.4%-27.0%). The incidence of POAF among those who underwent the standard technique was 37.7% (95% CI: 28.0%-47.8%). The patients who underwent a pleuro-pericardial window had a higher incidence of dyslipidemia (p = 0.037), right bundle branch block (p = 0.018), 1st-degree atrioventricular block (p = 0.046), and previous myocardial infarction (p = 0.006). Multivariate analysis showed that the risk of POAF was significantly lower in patients who underwent a pleuro-pericardial window compared to those who did not (odds ratio: 0.46, 95% CI: 0.24-0.87, p = 0.019).

Conclusion: Creating a right pleuro-pericardial window before closing the chest after cardiac surgery was independently associated with a lower incidence of POAF.