Posterior cardiac drain for atrial fibrillation after aortic valve replacement

Background: Postoperative atrial fibrillation occurs in 27% to 40% of patients after cardiac surgery. One cause of postoperative atrial fibrillation is pericardial effusion, which can be a significant source of inflammation. In this study, we investigated the effect of a drain placed in a posterior site to the heart to reduce pericardial effusion in the early postoperative period to prevent postoperative atrial fibrillation.

Methods: Participants were patients who underwent initial standby aortic valve replacement at Saga-Ken Medical Centre Koseikan from January 2010 to December 2021. Patients with a history of atrial fibrillation, complex surgery, or emergency surgery were excluded. The patients were divided into two groups: those with a posterior cardiac drain in addition to the usual intrapericardial and subpleural drains from September 2017 (group P) and those without posterior cardiac drain from January 2010 to August 2017 (group N). Multiple logistic regression analysis was performed to evaluate the usefulness of posterior cardiac drain.

Results: Of the 79 patients included the study, 40 were male and groups P and N comprised 27 and 52 patients, respectively. Of the 79 patients, 32 developed postoperative atrial fibrillation; among whom, 7/27 (25.9%) had posterior cardiac drain and 25/52 (48.1%) had no posterior cardiac drain (p = 0.09). When adjusted for body surface area, left ventricular end-diastolic and left atrial diameter, the incidence of postoperative atrial fibrillation was significantly lower in group P than in group N (adjusted odds ratio 0.270, 95% confidence interval 0.077-0.953, p = 0.042). Furthermore, no patient in the group P underwent postoperative thoracentesis in the subanalysis.

Conclusions: The results suggest that early postoperative reduction of pericardial effusion by posterior cardiac drain placement may reduce the incidence of postoperative atrial fibrillation.