Effects of pericardial incision on circulation and body oxygenation in pediatric patients with congenital heart disease

To evaluate the influence of pericardial incision (PI) on circulation and body oxygenation and identify factors influencing them in pediatric patients undergoing surgery for congenital heart disease (CHD). Prospective observational study. Gunma Children's Medical Center from August 4, 2022 to May 30, 2025. We evaluated 63 patients aged 0–18 years with CHD undergoing elective cardiovascular surgery. Blood pressure (BP), central venous pressure (CVP), and tissue oxygenation index (TOI), representing systemic oxygenation, were measured before and after PI during surgery and compared between the pre- and post-incision periods. Univariate (logistic) regression analysis was performed with the age and type of disease set as explanatory variables. Systolic (sBP), diastolic (dBP), and mean blood pressure (mBP) significantly decreased after PI. CVP significantly increased from 4.93 (1.96) to 6.08 (2.47), P = 0.00005, CI = −1.6733 to −0.5889, ES = 0.53 (medium). TOI significantly decreased from 71.22 (7.25) to 70.41 (7.79), P = 0.00631, CI = 0.403–1.56, ES = 0.37 (small to medium). Age was the only significant explanatory variable to decrease the TOI value (coefficient (coef) = 0.0004, P = 0.0301, CI = 0.000113 to 0.0.000797). PI increases venous congestion and reduces arterial pressure, leading to a decline in systemic oxygenation in patients with CHD. Therefore, age exhibits the most detrimental effect on this pathological condition. • Pericardial incision's paradoxical effects, contrary to past reports, were observed. • Pericardial incision disrupted the hemodynamics of patients with CHD. • The pericardium may be important in maintaining heart function.