Association between cardioplegia and postoperative atrial fibrillation in coronary surgery

Area of Science:

• Cardiology
• Cardiac Surgery
• Cardioplegia Research

Background:

• Postoperative atrial fibrillation (POAF) is a common complication after cardiac surgery.
• The type of cardioplegia used (cold vs. warm) may influence the incidence of POAF and subsequent outcomes.
• Understanding the association between cardioplegia and POAF is crucial for improving patient prognosis.

Purpose of the Study:

• To evaluate the association between cold and warm cardioplegia and the occurrence of POAF.
• To determine the prognostic role of POAF on early stroke and neurological mortality.
• To compare the incidence of POAF and related outcomes between warm and cold cardioplegia strategies.

Main Methods:

• Retrospective analysis of prospectively collected data from 9 centers (Italy and US) between 2010-2018.
• Inclusion of 17,231 patients undergoing isolated on-pump CABG, with matched cohorts (n=8324) and propensity-weighted analysis (n=11,830).
• Comparison of POAF rates, stroke incidence, and mortality between warm and cold cardioplegia groups.

Main Results:

• The overall POAF rate was 18%, with significantly higher rates in the cold cardioplegia group (21%) compared to the warm group (15%).
• Cold cardioplegia was independently associated with increased POAF, stroke, and neurological mortality.
• Both cold blood and cold crystalloid cardioplegia negatively impacted POAF, stroke, and neurological mortality.

Conclusions:

• Warm cardioplegia is associated with a lower rate of POAF in CABG patients compared to cold cardioplegia (blood or crystalloid).
• The choice of cardioplegia has a prognostic impact on the risk of postoperative stroke and neurological mortality.
• Warm cardioplegia may be a strategy to mitigate POAF and improve outcomes in CABG surgery.