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Published on: September 15, 2023
Off-pump coronary artery bypass grafting does not decrease the incidence of atrial fibrillation
Thomas Salamon1, Robert E Michler, Kelly M Knott
1Division of Cardiothoracic Surgery, The Ohio State University Medical Center, Columbus, Ohio, USA.
Insights
Avoiding cardiopulmonary bypass during coronary artery bypass grafting did not reduce the incidence of postoperative atrial fibrillation. This study found no significant benefit in preventing this common complication by omitting cardiopulmonary bypass.
Area of Science:
- Cardiovascular Surgery
- Cardiac Anesthesia
- Cardiac Surgery Outcomes
Background:
- Postoperative atrial fibrillation is a common complication after coronary artery bypass grafting (CABG).
- The use of cardiopulmonary bypass (CPB) is a known risk factor for developing atrial fibrillation.
- This study investigated whether avoiding CPB could lower the incidence of postoperative atrial fibrillation.
Purpose of the Study:
- To determine if eliminating cardiopulmonary bypass during CABG surgery reduces the occurrence of postoperative atrial fibrillation.
- To compare the incidence of atrial fibrillation in patients undergoing off-pump CABG versus on-pump CABG.
Main Methods:
- A retrospective review of 2,569 patients undergoing CABG was conducted.
- Patients were divided into four groups: off-pump CABG (n=252), on-pump CABG (n=1,470), on-pump CABG with similar grafts (n=841), and historical on-pump CABG (n=847).
- Prophylactic beta-blockade was administered to groups 1-3 but not group 4.
Main Results:
- The incidence of atrial fibrillation was 8.8% in the off-pump group (group 1).
- Incidences in the on-pump groups were 11.6% (group 2), 9.4% (group 3), and 28.0% (group 4).
- The difference in atrial fibrillation incidence between group 1 and group 4 was statistically significant (p <.0001).
Conclusions:
- Avoiding cardiopulmonary bypass did not significantly reduce the incidence of postoperative atrial fibrillation at this institution.
- The findings suggest that off-pump CABG may not be superior to on-pump CABG for preventing atrial fibrillation.
- Further research may be needed to identify optimal strategies for reducing postoperative atrial fibrillation after CABG.
Background:
Postoperative atrial fibrillation remains a significant source of morbidity after coronary artery bypass grafting. We reviewed the data on 2,569 patients to determine if the absence of cardiopulmonary bypass resulted in a lower incidence of atrial fibrillation.
Methods:
All patients undergoing coronary artery bypass grafting without cardiopulmonary bypass from January 1, 1997 through June 30, 2001 were evaluated for postoperative atrial fibrillation. The data of 252 patients with no cardiopulmonary bypass (group 1) were reviewed and compared with three other patient groups. Group 2 consisted of 1,470 patients using cardiopulmonary bypass during the same study period. Group 3 consisted of 841 patients with a similar number of grafts as the study group but using cardiopulmonary bypass. Group 4 consisted of historical data for 847 patients operated on using cardiopulmonary bypass collected from January 1995 through December 1996. Prophylactic beta-blockade was instituted in January 1997. Groups 1 to 3 received this treatment, but group 4 did not.
Results:
Group 1 had an incidence of atrial fibrillation of 8.8%. Groups 2, 3, and 4 had incidences of atrial fibrillation of 11.6%, 9.4%, and 28.0%, respectively. When compared with group 1, the incidence of atrial fibrillation in group 4 was statistically different (p <. 0001).
Conclusions:
Avoiding cardiopulmonary bypass did not aid the reduction of atrial fibrillation at our institution.
