Simple surgical technique associated with significant reduction in the
risk of atrial fibrillation after cardiac surgery

Date:
November 15, 2021
Source:
Weill Cornell Medicine
Summary:
A simple surgical technique during cardiac surgery was associated
with a 56 percent reduction in the incidence of an irregular heart
rhythm known as atrial fibrillation that can lead to stroke, with no
added risks or side effects, according to a new study. The findings
suggest that the method, called posterior left pericardiotomy, has
significant potential for preventing prolonged hospital stays and
the need for additional interventions and drugs to reduce the risk
of strokes and heart failure associated with atrial fibrillation.



FULL STORY ==========================================================================
A simple surgical technique during cardiac surgery was associated with a
56 percent reduction in the incidence of an irregular heart rhythm known
as atrial fibrillation that can lead to stroke, with no added risks
or side effects, according to a new study by Weill Cornell Medicine
and NewYork-Presbyterian investigators. The findings suggest that the
method, called posterior left pericardiotomy, has significant potential
for preventing prolonged hospital stays and the need for additional interventions and drugs to reduce the risk of strokes and heart failure associated with atrial fibrillation.


==========================================================================
The study evaluated whether a posterior left pericardiotomy, a slit in
the backside of the sac around the heart to drain excess fluid, could
help prevent atrial fibrillation in patients who underwent cardiac
surgeries. The randomized controlled trial was published Nov. 14 in
The Lancet. Study investigators also presented the findings in a live
virtual Late-Breaking Science session on Nov.

14 as part of the American Heart Association's Scientific Sessions 2021.

"Previous studies were small with major limitations in study design, so
there was no clear direction on whether posterior left pericardiotomy is beneficial for preventing atrial fibrillation," said lead investigator
Dr. Mario Gaudino, the Stephen and Suzanne Weiss Professor in
Cardiothoracic Surgery at Weill Cornell Medicine and a cardiothoracic
surgeon at NewYork-Presbyterian/Weill Cornell Medical Center. "Our study
is the first to provide rigorous evidence of the benefits of the technique
in a large group of patients at a single institution." A buildup of
excess fluid and small clots is common after cardiac surgery, occurring
in about two-thirds of patients. Even a small buildup can trigger the development of atrial fibrillation, a complication in which irregular electrical signals prevent the heart's upper chambers from contracting effectively. Atrial fibrillation is the most frequent adverse event after
heart surgery, reported in about 35 percent of patients. Treatment may
involve an electrical shock to restore a regular heart rhythm, followed
by taking drugs for controlling heart rhythm and lowering the risk of
blood clots, which all have side effects and complications.

To perform a posterior left pericardiotomy, the surgeon makes an incision
in the back side of the sac around the heart, called the pericardium. This allows excess fluid and small clots from the pericardium to drain into
the space around the left lung, called the left pleural cavity. The
procedure adds just a few minutes to the overall cardiac surgery time. A
left pleural drainage tube is inserted and generally removed few days
after surgery as part of standard care. Excess fluid continues to drain
through the slit in the pericardium until it heals on its own.

For their study, called "Posterior Left Pericardiotomy for the Prevention
of Postoperative Atrial fibrillation after Cardiac Surgery" (PALACS),
the investigators randomly assigned 420 patients undergoing elective
surgery to coronary arteries, the aortic valve or ascending aorta
to two groups: 212 patients received a posterior left pericardiotomy
during their surgeries and 208 patients did not receive the additional
surgical procedure.

Atrial fibrillation developed in 37 of 212 patients (18 percent) in the pericardiotomy group, significantly lower than 66 of 208 patients (32
percent) in the no-pericardiotomy group. Importantly, no complications
were associated with pericardiotomies.

The study was funded entirely by the Department of Cardiothoracic
Surgery at Weill Cornell Medicine, made possible through philanthropy
from patients and fundraising efforts. "This study demonstrates our
commitment to conducting rigorous clinical research and answering
important questions that are meaningful to patients," said Dr. Gaudino,
who is also director of the Joint Clinical Trials Office at Weill Cornell Medicine and NewYork-Presbyterian.

Drs. Gaudino and a team of investigators from the Department of
Cardiothoracic Surgery at Weill Cornell Medicine are now working with international colleagues to design a multicenter clinical trial that
will include more patients and types of heart surgeries, such as mitral
valve repair.

"We are excited that our proof-of-concept clinical trial has
demonstrated the benefits of posterior left pericardiotomy, with no
additional risks to patients," said senior author Dr. Leonard Girardi,
chairman of the Department of Cardiothoracic Surgery and the O. Wayne
Isom Professor of Cardiothoracic Surgery at Weill Cornell Medicine,
and cardiothoracic surgeon-in-chief at NewYork-Presbyterian/Weill
Cornell Medical Center. "We look forward to confirming our results in
a multicenter study in the future and hope this technique may one day
become the standard of care for heart surgery patients across the globe." ========================================================================== Story Source: Materials provided by Weill_Cornell_Medicine. Note:
Content may be edited for style and length.


========================================================================== Journal Reference:
1. Mario Gaudino, Tommaso Sanna, Karla V Ballman, N Bryce Robinson,
Irbaz
Hameed, Katia Audisio, Mohamed Rahouma, Antonino Di Franco,
Giovanni J Soletti, Christopher Lau, Lisa Q Rong, Massimo Massetti,
Marc Gillinov, Niv Ad, Pierre Voisine, J Michael DiMaio, Joanna
Chikwe, Stephen E Fremes, Filippo Crea, John D Puskas, Leonard
Girardi. Posterior left pericardiotomy for the prevention of atrial
fibrillation after cardiac surgery: an adaptive, single-centre,
single-blind, randomised, controlled trial. The Lancet, 2021;
DOI: 10.1016/S0140-6736(21)02490-9 ==========================================================================

Link to news story: https://www.sciencedaily.com/releases/2021/11/211115123504.htm

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