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[Volume of Coronary Artery Bypass Surgery and Risk of Postoperative Atrial Fibrillation]
O A Rubanenko1,2, O V Fatenkov1,2, S M Khokhlunov1,2
1Samara State Medical University, Samara, Russia.
Insights
Postoperative atrial fibrillation (AF) is more common after multivessel coronary artery bypass grafting (CABG) than single-vessel procedures. Left atrial size is the strongest predictor of AF in these patients.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common complication following cardiac surgery.
- The relationship between the extent of coronary artery bypass grafting (CABG) and AF prevalence requires further investigation.
Purpose of the Study:
- To determine the prevalence of atrial fibrillation (AF) in relation to the volume of coronary artery bypass grafting (CABG) performed.
- To identify risk factors for postoperative AF in patients undergoing CABG.
Main Methods:
- Retrospective analysis of 431 patients with ischemic heart disease (IHD) who underwent CABG.
- Patients were divided into single-vessel and multivessel bypass groups.
- Multivariate analysis was used to identify predictive factors for postoperative AF.
Main Results:
- Postoperative AF occurred in 18.0% of patients with multivessel CABG versus 6.4% with single-vessel CABG.
- Significant predictors of AF included aortic cross-clamping time >36 min, ischemia time >19 min, age >59 years, left atrial dimension >39 mm, and left ventricular ejection fraction <51%.
- Left atrial dimension >39 mm was the most powerful predictor of AF.
Conclusions:
- Multivessel CABG is associated with a higher incidence of early postoperative AF compared to single-vessel CABG.
- Left atrial dimension exceeding 39 mm is the most significant predictor of AF in patients undergoing CABG.
Purpose:
To identify prevalence of atrial fibrillation (AF) in dependence of volume of coronary artery bypass grafting (CABG) as assessed by the number of grafts.
Material And Methods:
The study included 431 patients with ischemic heart disease (IHD) who underwent CABG. Group 1 comprised patients with single-vessel bypass graft (n=47, 78.7% men, mean age 59.6+/-5.6 years), group 2 - with multivessel bypass grafts (n=384, 76.8% men, mean age 61.0+/-8,1 years). During the observation period postoperative AF developed in 3 patients (6.4%) with single vessel bypass graft and 69 patients (18.0%) with multivessel bypass grafts. At multivariate analysis predictive values were significant for the following parameters: aortic cross-clamping time >36 min - 1.7 (95% confidence interval [CI], 1.1-3.2, p=0.03), ischemia time >19 min - 2.0 (95% CI, 1.1-3.7, p=0.02), age >59 years - 2.4 (95% CI, 1.3-4.4, p=0.005), left atrial dimension >39 mm - 3.7 (95% CI, 2.1-6.6, p<0.0001), left ventricular ejection fraction <51% - 1.9 (95% CI, 1.3- 3.3, p=0.04). Predictive value of cardiopulmonary bypass time >56 min 1.2 (95% CI, 0.56-2.8) was not significant (p=0.5).
Conclusion:
In our study AF in the early postoperative period more often occurred in patients who underwent multivessel coronary bypass surgery. The most powerful predictor of AF in these patients was left atrial dimension exceeding 39 mm.
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