Pericardiotomy in Cardiac Surgery

Approximately 30% of cardiac surgical patients develop post-operative atrial fibrillation (POAF). Its incidence varies depending on the type of cardiac operation. POAF is associated with short- and long-term adverse events, including mortality, stroke, and heart failure. POAF has also been significantly associated with unplanned hospitalization for heart failure.

During cardiac surgery, pericardial fluid tends to collect posterior to the left atrium. Even small amounts of fluid may trigger atrial arrhythmias. A posterior left pericardiotomy is a surgical procedure that involves cauterizing an opening between the left inferior pulmonary vein and the diaphragm. This procedure may allow for more prolonged drainage of the pericardial fluid into the left pleural space. Recent research evidence found that posterior pericardiotomy was associated with a significantly lower incidence of POAF.

The existing data on posterior pericardiotomy is promising for a reduction in POAF. However, no high-quality study has demonstrated that this reduction improves clinical outcomes in the years after cardiac surgery. The PRINCE trial's long-term follow-up of patients randomized to left posterior pericardiotomy could conclusively demonstrate whether the relationship of POAF to post-discharge clinical outcomes is causal and modifiable.

The PRINCE trial will evaluate the effectiveness and safety of posterior left pericardiotomy in preventing POAF and improving post-discharge clinical outcomes in a broad spectrum of cardiac surgery patients.

The intervention under investigation is left posterior pericardiotomy which is compared to no posterior pericardiotomy during cardiac surgery. The early co-primary outcome is in-hospital POAF, and the late co-primary outcome is the hierarchical composite of time to all-cause death, time to ischemic stroke, time to systemic arterial embolism, time to unplanned hospital visit/readmission for cardiac reasons, and time to atrial fibrillation after index hospital discharge.

The study will enrol 1400 patients from 30 centres, globally. Follow-up visits will be performed in person or by telephone 1 and 6 months post-randomization (+7 days), and then every 6 months (+30 days) until an average follow-up of 5 years for the study participants (estimated to be 4 years after completion of enrolment).

• Post-operative atrial fibrillation (POAF) [Срок оценки: Over the duration of the follow-up period to a common end date (mean follow-up of 5 years).]
• Length of post-operative in-hospital stay [Срок оценки: Over the duration of the follow-up period to a common end date (mean follow-up of 5 years).]
• Pericardial effusion without tamponade [Срок оценки: From index surgery completion to within 30 days of index surgery]
• Death [Срок оценки: From index surgery completion to within 30 days of index surgery]
• Ischemic stroke or systemic arterial embolism [Срок оценки: From index surgery completion to within 30 days of index surgery]
• Hospital readmission or unplanned hospital visit [Срок оценки: From index surgery completion to within 30 days of index surgery]
• Quality of life assessed by the European quality of life index version 5D (EQ-5D-5L) questionnaire [Срок оценки: Over the duration of the follow-up (mean follow-up of 5 years)]