This systematic review with meta-analysis sought to determine the impact of posterior
pericardiotomy on incidences of
atrial fibrillation and supraventricular arrhythmias,
pericardial effusion,
pleural effusion, tamponade, and the length of
hospital stay after cardiac surgery. We searched for randomized controlled trials, using Medline, Embase, Elsevier and Sciences online databases as well as Google Scholar literature. The effect sizes measured were odds ratio for categorical variables and standard mean difference with 95% confidence interval for calculating differences between mean values of
hospital stay in intervention and control groups. A value of p < 0.1 for Q test or I(2 )> 50% indicated significant heterogeneity between the studies. The literature search of all major databases retrieved 20 studies. After screening, 12 suitable trials were identified, which reported outcomes of 2052 patients undergoing cardiac surgery. Posterior
pericardiotomy had an odds ratio of 0.33 [95% confidence interval: 0.18-0.61] p < 0.001 for
atrial fibrillation; odds ratio 0.32 [0.15-0.67] p = 0.003 for supraventricular arrhythmias; odds ratio 0.09 [0.04-0.19] p = 0.000 for early
pericardial effusion and odds ratio 0.04 [0.02-0.08] p < 0.001 for late
pericardial effusion; odds ratio 1.64 [1.23-2.20] p = 0.001 for
pleural effusion, odds ratio 0.07 [0.02-0.27] p < 0.001 for tamponade, and standard mean difference = 0.01 [-0.12 to 0.14] p = 0.8 for
hospital stay. Posterior
pericardiotomy is a simple intraoperative technique that can improve postoperative clinical outcomes. However, the incidence of
pleural effusion associated with posterior
pericardiotomy might be higher.