Pericardial Reconstruction Using an Extracellular Matrix Implant Correlates with Reduced Risk of Postoperative Atrial Fibrillation in Coronary Artery Bypass Surgery Patients

Background: Postoperative atrial fibrillation (AF) is a significant complication following open heart surgery, with potentially serious clinical and economic implications. To assess the effect of a novel procedure, pericardial reconstruction using a porcine-derived extracellular matrix (ECM) implant, on the risk of postoperative AF after primary isolated coronary artery bypass grafting (CABG), we performed a retrospective comparison of the incidence of postoperative AF in patients who underwent this procedure versus an untreated control group. Methods: We performed a retrospective comparison of the incidence of postoperative AF in 111 patients who underwent a pericardial reconstruction procedure with the CorMatrix ECM for Pericardial Closure (CorMatrix Cardiovascular, Atlanta, GA, USA) following primary isolated CABG, versus a control group of 111 patients who did not undergo pericardial reconstruction. Results: Postoperative AF occurred in 43 of 111 control patients (39%; lower control limit [ LCL], 30%; upper control limit [ UCL], 49%) but in only 20 of 111 treated patients (18%; LCL, 11%; UCL, 27%). This result represents a 54% reduction in relative risk in the treatment group (P < .001). There was a small but statistically insignificant decrease in the hospital length of stay for the treated patients. The 2 treatment groups exhibited similar postoperative complication profiles. Conclusions: In this retrospective study, pericardial reconstruction with the ECM implant contributed directly to a statistically significant and clinically meaningful reduction in the rate of postoperative AF in patients undergoing primary isolated CABG. A prospective multicenter randomized trial has been planned to further test this approach.