Reply to the commentary of Soletti and colleagues

Fibrillation After Cardiac Surgery: A Propensity Score-Matched Study," published in The Journal of Thoracic and Cardiovascular Surgery Open. 2 Our nonrandomized study, 2 with its limitations, focuses on the use of an additional posterior pericardial chest tube to reduce the incidence of postoperative atrial fibrillation (POAF) after open cardiac surgery, a relatively simple and cheap method that has been poorly studied.We agree with Soletti and colleagues 1 on the importance of removing retained fluid in the pericardium, as evidence supports that drainage of the posterior pericardium reduces the rate of POAF. 3 We also agree with Soletti and colleagues 1 that this goal can be achieved with posterior left pericardiotomy. 3,4n our study, we pointed out that posterior pericardiotomy is more extensively studied than the use of a posterior pericardial chest tube in reducing POAF and has the benefit of prolonged drainage compared with a pericardial chest tube that is removed relatively soon after surgery.Furthermore, we emphasized that both methods are regarded as safe: "While posterior pericardiotomy and chest tubes are not entirely free of risk, they are generally considered to be simple and safe interventions."However, for the sake of full transparency, we noted the potential complications of both methods: "Although very rare, there have also been individual reports of protrusion of the left atrial appendix through the pericardial incision causing compression on the vein grafts, and bleeding from the pericardial incisional edges after posterior pericardiotomy."We did not leave out potential complications related to pericardial chest tubes: "Displacement of a pericardial drain can also cause compression of vein grafts." 2 These risks have been mentioned previously in numerous publications, [3][4][5] including by Gaudino and colleagues 4 from 2021.Therefore, it was surprising to see the final statement by Soletti and colleagues 1 : "In an era where debate is being abandoned in favor of polarization, and the basic academic principles of open, objective discussion are falling out of favor, we believe that scientific works should still be based on an impartial and open-minded evaluation of the available data, rather than partisanism and ideologic contraposition."However, upon further reflection, we believe our colleagues 1 are speaking in broader terms, referring to the science and academic work in generalrather than to our paper specifically-since we share their advocacy for transparency and maintaining an open academic and clinical mindset.This includes the consideration of alternative treatment methods as complements and additional tools for improving patient outcomes rather than competition.