Does posterior pericardial window technique prevent pericardial tamponade after cardiac surgery?

• Published in: Journal of international medical research Vol. 42; no. 2; pp. 416 - 426
• Main Authors: Zhao, Jian, Cheng, Zhaoyun, Quan, Xiaoqiang, Zhao, Ziniu
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.04.2014; Sage Publications
• Subjects: Atrial Fibrillation - epidemiology; Biological and medical sciences; Cardiac dysrhythmias; Cardiac Tamponade - epidemiology; Cardiac Tamponade - prevention & control; Cardiology. Vascular system; Diseases of the pericardium; Drainage; Female; Heart; Heart Arrest - epidemiology; Humans; Intubation, Intratracheal; Male; Medical sciences; Middle Aged; Pericardial Effusion - epidemiology; Pericardial Window Techniques; Pharmacology. Drug treatments; Postoperative Complications - epidemiology; Postoperative Complications - prevention & control; Prospective Studies; Treatment Outcome; Pericardial window; atrial fibrillation; tamponade; drainage; cardiac; surgery; Heart; Arrhythmia; Atrial fibrillation; Cardiac tamponade; Cardiovascular disease; Excitability disorder; Heart disease; Surgery; Pericardial disease
• ISSN: 0300-0605; 1473-2300
• DOI: 10.1177/0300060513515436

Objective To investigate the efficacy of the intraoperative posterior pericardial window technique in preventing pericardial tamponade following open heart surgery. Patients and methods Adult patients undergoing coronary and/or valve surgery were randomly divided into a control (traditional) or a pericardial window (PW) technique group. Pre-, intra-, peri- and postoperative clinical data were collected prospectively, including incidence of pericardial tamponade, cardiac arrest, drainage volume, ventilation assistance time and moderate-to-large pericardial effusion. Results In total, 458 patients were included: 230 controls and 228 in the PW group. The incidence of pericardial tamponade in the PW group was significantly lower than in controls. Cardiac arrest occurred in one patient (0.4%) in the PW group and five (2.2%) controls; this difference was not statistically significant. Moderate-to-large pericardial effusion after drainage extubation and new-onset atrial fibrillation were significantly more common in controls than in the PW group. After stratification by age (≤70 versus >70 years), there was no between-group difference in duration of endotracheal intubation, although in the PW group, after removal of the tracheal cannula, duration of noninvasive positive pressure ventilation was significantly longer in older patients. Conclusions The pericardial window procedure did not increase the rate or severity of procedure-related complications. This simple technique significantly decreased the incidence of postoperative pericardial tamponade and new-onset atrial fibrillation.