Pericardial Closure Preserves Early Right Ventricular Function After Cardiac Surgery: A Retrospective Cohort Study

The Thoracic and Cardiovascular Surgeon, vol. 74, pp. S1–S70

Abstract

All articles of this category (opens in new window) Background: Perioperative right ventricular (RV) dysfunction is common after cardiac surgery and is associated with worse short-term outcomes. Loss of pericardial restraint after pericardiotomy is a plausible mechanism for early postoperative declines in RV longitudinal function. Methods: We performed a retrospective cohort study of consecutive adult patients who underwent isolated coronary or aortic valve surgery and had technically sufficient transthoracic echocardiography before and within 7 days after the operation. Patients were grouped according to the surgeon’s practice: pericardium left open (Open) vs. pericardium closed at the end of the operation (Closed). RV systolic performance was assessed with conventional indices (TAPSE, TASV, RV-FAC) and speckle-tracking echocardiography (RV free-wall strain and strain-rate). Changes from pre- to postoperative measurements were compared within and between groups using repeated measures ANOVA with Holm adjustment; p < 0.05 was considered significant. Results: Ninety-seven patients met the inclusion criteria (Open n = 32, Closed n = 65). Both groups experienced declines in multiple systolic indices after surgery; however, the Closed group showed significantly better preservation of RV longitudinal function postoperatively. Postoperative TAPSE was higher in the Closed group (14.6 ± 3.1 mm vs. 12.9 ± 3.1 mm; p = 0.015), and TASV was higher (9.8 ± 2.7 vs. 7.9 ± 2.5 cm/s; p = 0.003). Postoperative LV global longitudinal strain was also less depressed in the Closed group (−15.1 ± 3.7% vs. −16.9 ± 3.7%; p < 0.001). These differences persisted after adjustment for baseline characteristics. Conclusion: Pericardial closure after cardiac surgery is associated with improved early postoperative RV longitudinal function compared with leaving the pericardium open. These findings support a protective role of pericardial integrity on RV performance in the early postoperative period and suggest that surgical pericardial management merits consideration in strategies to preserve RV function after cardiac surgery. Publication History Article published online: 17 February 2026 © 2026. Thieme. All rights reserved. Georg Thieme Verlag KG Oswald-Hesse-Straße 50, 70469 Stuttgart, Germany

Authors 4

1. Nima Hatam Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

2. Rashad Zayat Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

3. H.-W.M. Breuer Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland

4. A. Moza Aachen

   Universitätsklinikum Aachen · RWTH Aachen University

   Affiliation as printed

   RWTH Aachen University Hospital, Aachen, Deutschland