Effect of posterior pericardiotomy on early and late pericardial effusion after valve replacement

Abstract

Pericardial effusion (PE) after cardiac surgery is frequent. It is more frequently seenafter valve replacement or other types of heart surgery. Oral anticoagulants and antiplatelet agents mayinduce effusion development after open heart surgery. Our objective was to determine the efficiency ofposterior pericardiotomy (PP) after cardiac valve operation for reducing the incidence of early and late PEand tamponade.Methods: This prospective randomized study was carried out in 100 consecutive patientsundergoing mechanical valve replacement between August 2001 and May 2003 in our institution. Patientswere divided into two groups; each group consisted of 50 patients. Longitudinal incision was made paralleland posterior to the left phrenic nerve, extending from the left inferior pulmonary vein to the diaphragm inGroup 1. Posterior pericardiotomy was not done in Group 2.Results: Early PE was detected in four patients(8%) and in 19 patients (38%) in Group 1 and Group 2, respectively (p < 0.001). No late PE effusion wasdeveloped in Group 1 despite nine (18%) late PE developing in Group 2 (p < 0.003). The rate of delayedpericardial tamponade was lower in Group 1, but this difference was not statistically significant (0% vs 10%;p < 0.056).Conclusion: These findings suggest that PP is an easy, feasible, and beneficial technique forreducing both the occurrence of early and late PE or pericardial tamponade in patients undergoing valvereplacement.