The effects of pleurotomy and drainage strategies in coronary artery bypass surgery on postoperative atrial fibrillation

Aims: The aim of this study was to evaluate the effect of preserving pleural integrity and the drainage strategy on postoperative atrial fibrillation (POAF) in patients undergoing coronary artery bypass grafting (CABG) using the left internal mammary artery (LIMA). Methods: A retrospective analysis was conducted on 533 patients who underwent elective isolated CABG under cardiopulmonary bypass between January 2021 and March 2025. Patients were divided into two groups based on pleural management and drainage methods. Group 1 (n=442) comprised patients who underwent pleurotomy and had an intercostal drain placed; group 2 (n=91) comprised patients in whom the pleura was preserved and a posterior cardiac drain was placed. Results: The incidence of POAF was significantly lower in group 2 (34.2% vs 17.5%; p<0.001). Pain scores were significantly lower in group 2 (VAS 3±0.7 versus 8±1.2; p<0.001) and total drainage volume was lower (370±40 ml versus 450±90 ml; p<0.001). Oxygenation parameters were better in group 2. However, the duration of surgery was significantly longer in group 2 (172±33 min versus 203±29 min; p<0.001). Conclusion: Preserving pleural integrity and using posterior cardiac drainage may reduce the incidence of POAF and positively influence postoperative recovery. However, this approach may lead to an increase in operative time.