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

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.