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J Thorac Cardiovasc Surg 2006;132:27-31
© 2006 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Effect of posterior pericardial drainage on the incidence of pericardial effusion after ascending aortic surgery

Department of Cardiovascular Surgery, Ankara University, School of Medicine, Ankara, Turkey.

Received for publication October 25, 2005; revisions received December 30, 2005; accepted for publication January 13, 2006.

^_* Address for reprints: Ozan Emiroglu, MD, Ankara University, School of Medicine, Department of Cardiovascular Surgery, Cebeci Kalp Merkezi, Dikimevi, 06620 Ankara, Turkey. (Email: ozanemiroglu{at}mail.com).

OBJECTIVE: Pericardial effusion and cardiac tamponade after ascending aortic surgery are higher than anticipated after cardiac surgery. We evaluated a thin closed-suction drain system to prevent posterior pericardial effusion in patients undergoing ascending aortic surgery.

METHODS: One hundred forty patients who underwent ascending aortic surgery were prospectively randomized into group A and group B. In group A (n = 70) we used a 32F drain placed anteriorly overlying the heart and a 16F thin drain placed retrocardially. In group B (n = 70) only a 32F drain placed anteriorly was used. In group A we removed the large drain on the first postoperative day and continued drainage with the thin drain until the drainage was less than 50 mL in a 24-hour period. In group B we removed the drain after the first postoperative day when the drainage was less than 50 mL in an 8-hour period. Preoperative, perioperative, and postoperative parameters of the patients were compared.

RESULTS: No significant posterior pericardial effusion and late cardiac tamponade developed in patients in group A. In group B 10 (14.3%) patients experienced significant posterior pericardial effusion and 4 (5.7%) patients experienced late cardiac tamponade; the incidence of significant pericardial effusion in group B was significantly higher (P = .001). Postoperative new-onset atrial fibrillation developed in 6 (10.4%) patients in group A and in 18 (32.7%) patients in group B (P = .03).

CONCLUSIONS: We demonstrated that effective posterior drainage is important to prevent posterior pericardial effusion, and use of a thin drain placed retrocardially appears to be sufficient for these results.

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