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Atrial fibrillation after beating heart surgery
S C Stamou1, G Dangas, P C Hill
1Division of Cardiac Surgery, Department of Surgery, MedStar Research Institute, Washington Hospital Center, Washington, DC, USA.
Insights
Postoperative atrial fibrillation (AF) after coronary artery bypass grafting (CABG) increases hospital stay and mortality. Minimally invasive direct CABG reduces AF risk, highlighting its benefit in preventing this common complication.
Area of Science:
- Cardiology
- Cardiac Surgery
Background:
- Postoperative atrial fibrillation (AF) is a common complication following coronary artery bypass grafting (CABG).
- AF can negatively impact early clinical outcomes after CABG.
- Investigating AF in off-pump CABG is crucial for improving patient care.
Purpose of the Study:
- To identify risk factors for postoperative AF in patients undergoing off-pump CABG.
- To determine the prevalence and prognostic implications of AF in this patient group.
- To evaluate the impact of surgical approach on AF incidence.
Main Methods:
- Retrospective analysis of 969 patients undergoing off-pump CABG from 1987 to 1999.
- Exclusion of patients with preoperative AF.
- Statistical analysis to identify predictors and outcomes associated with AF.
Main Results:
- 206 patients (21.3%) developed postoperative AF.
- Predictors of AF included advanced age (>75 years), history of stroke, and postoperative pleural effusion or pulmonary edema.
- Minimally invasive direct CABG was associated with a significantly lower incidence of AF (OR 0.4).
- AF correlated with prolonged hospital stay (9 vs 6 days), higher in-hospital mortality (3% vs 1%), and increased stroke rates in persistent AF cases.
Conclusions:
- Postoperative AF in off-pump CABG patients is linked to increased morbidity, mortality, and extended hospital stays.
- Minimally invasive direct CABG demonstrates a reduced risk of AF.
- Identifying and mitigating AF risk factors is essential for improving outcomes in CABG patients.
Abstract:
Postoperative atrial fibrillation (AF) is a frequent adverse event after coronary artery bypass grafting (CABG) and may negatively affect the early clinical outcome. We sought to investigate the risk factors, prevalence, and prognostic implications of postoperative AF in patients submitted to CABG without cardiopulmonary bypass (off-pump). The study population comprised 969 patients, 645 men (67%) and 324 women (33%) who had off-pump CABG at the Washington Hospital Center from January 1987 to May 1999. Preoperative AF patients were excluded (n = 15). Two hundred six patients (age 69 +/- 10 years, 137 men [66%]) developed AF, whereas 763 patients (age 61 +/- 12 years, 508 men [67%]) did not. Predictors of AF included age >75 years (odds ratio [OR] 3.0, 95% confidence interval [CI] 1.9 to 4.5; p <0.001), history of stroke (OR 2.1, CI 1.2 to 3.7; p = 0. 007), postoperative pleural effusion requiring thoracentesis (OR 3.2, CI 1.0 to 9.4; p = 0.03), and postoperative pulmonary edema (OR 5.1, CI 1.2 to 21; p = 0.02). Minimally invasive direct CABG was associated with a lower incidence of AF (OR 0.4, CI 0.3 to 0.7; p <0. 001). AF was associated with a prolonged postoperative hospital stay (9 +/- 6 days AF vs 6 +/- 5 days no AF, p <0.001). In-hospital mortality was significantly higher in AF patients (3% AF vs 1% no AF, p = 0.009). Patients with persistent AF had a higher postoperative in-hospital stroke rate than patients without persistent AF (9% vs 0. 6%, p <0.001). AF after beating heart surgery is associated with a higher in-hospital morbidity, mortality, and prolonged hospital stay. A minimally invasive surgical approach (minimally invasive direct CABG) is associated with a lower risk of AF.