Incidence Of Postoperative Atrial Fibrillation Research Articles

PO-01-235 EPICARDIAL PULSED-FIELD ABLATION OF THE CARDIAC GANGLIONATED PLEXI: IMPACTS ON THE AUTONOMIC NERVOUS SYSTEM

The autonomic nervous system (ANS) has been shown to play a role in the initiation and maintenance of atrial fibrillation (AF). While incidental ablation of the Ganglionated Plexi (GP) during AF ablation changes the ANS in a manner which correlates with procedural success, targeted ablation of GP has met with mixed results. In pre-clinical models, pulsed field (PF) energy delivered epicardially has demonstrated the capability to ablate GP without damage to surrounding myocardium. This is a first in human analysis to investigate the feasibility and safety of epicardial PF ablation (PFA) during cardiac surgery. In a single arm, prospective analysis, patients with or without a history of AF underwent epicardial PFA (OCED, AtriAN[RV1] Inc, Dublin) during planned coronary artery bypass grafting (CABG; see Figure). ANS tone was assessed via intraoperative pacing maneuvers to assess atrial effective refractoriness (AERP) and with Holter-assessment of heart rate variability (HRV) at baseline and 3 months post procedure. Most enrolled patients (23 of 24) received the full ablation protocol with no device-related adverse effects. Pacing demonstrated a 20.7±19.9% extension in AERP (P<0.001). Holter monitoring demonstrated an increase in mean heart rate (74.0±8.7 vs 80.6±12.3 BPM, P=0.01). While there was a trend towards a decrease in SDNN (188±31 vs 104±40, P=0.20), there were no significant changes in HRV. Post-operative AF (POAF) was noted in 7 (29%) of patients. This study demonstrates the safety and feasibility of epicardial PFA of the cardiac GP aimed at modulating the ANS during CABG. While changes in AERP suggest acute efficacy, assessment of the long-term effects and impact on the incidence of POAF is limited by the small sample size and single-arm nature of this analysis. Larger, randomized studies are needed to determine the long-term impact of epicardial PFA and its ability to mitigate POAF.

Comparison of Coronary Artery Bypass Grafting Outcomes in patients with and without Prior Percutaneous Coronary Artery Intervention

Percutaneous coronary intervention (PCI) is a crucial treatment for patients with coronary artery disease (CAD), especially high-risk patients like advanced age, diabetes, chronic kidney disease, left main lesions, and multi vessel CAD. Objective: To compare coronary artery bypass grafting outcomes in patients with and without prior percutaneous coronary artery intervention. Methods: This retrospective 5-year cross-sectional study was conducted on 2579 patients operated for CABG in between August 1st, 2017, and December 31st, 2021 in a tertiary care hospital. All patients who underwent CABG were included in study, and comparison was done in patients with or without PCI. Data analysis were done by using SPSS version 23. p&lt;0.05 was set statistically significant. Results: The results of perfusion and cross clamp time in operative room, use of IABP and reopening rates in both groups showed no statistically significant difference. The incidence of post-operative atrial fibrillation in group A is 4% Vs 1.5% in group B with significant p value of 0.028. Prolong ventilation, perioperative stroke and reintubation rates comparison in both groups were with non-significant p values. In hospital mortality was 4.5% in group A and 3.7% in group B with p-value of 0.370 which is non-significant. Conclusions: Patients with prior percutaneous coronary intervention can undergo CABG surgery with similar mortality rates as those with no prior PCI. The only significant difference in morbidity is post-operative risk of atrial fibrillation which is more in prior PCI patients’ group.

PO-01-020 PERI-OPERATIVE AMIODARONE PROPHYLAXIS IN CARDIOVASCULAR SURGERY: IMPACTS ON POST-OPERATIVE LENGTH OF STAY ACCORDING TO PROCEDURE TYPES

Post-operative Atrial Fibrillation (POAF), occurring in nearly 20-50 percent of cardiovascular surgery (CVS) patients, is associated with prolonged hospitalization and excess costs of care. Peri-operative Amiodarone prophylaxis has been an effective strategy to reduce the incidence of POAF. A retrospective evaluation of the impact of Amiodarone prophylaxis on post-operative length of hospital (LOS) stay, according to CVS procedure types. Hospitalization information was available for 2704 consecutive CVS patients at a single tertiary care centre (2013-2016). CVS included standalone, or combined procedures that involved: valvular heart surgery (VHS), coronary artery bypass graft (CABG), and other miscellaneous procedures (e.g. ascending aorta replacement, endarterectomy). Hierarchical linear regression was used to evaluate the impact of Amiodarone prophylaxis on LOS, adjusted for demographic and clinical characteristics. Among the 2704 patients, there were 866 (32.0%) cases of POAF. LOS, was significantly longer in patients with POAF (+2.78 days, p<0.001). LOS was 1.62 days shorter in patients who received Amiodarone prophylaxis (p=0.007). Within all operative categories, LOS was shorter in patients receiving amiodarone prophylaxis, though statistical significance was only observed in VHS (including VHS + other) and VHS + CABG procedure types. Specifically, Amiodarone prophylaxis was associated with shorter LOS among: patients who had CABG but not VHS (8.26 versus 9.45 days, p= 0.29), patients who had VHS but not CABG (7.62 versus 11.02 days, p<0.001), patients undergoing VHS + CABG (9.36 vs. 12.41 days, p<0.03), and patients undergoing VHS + CABG + other (13.54 versus 15.09 days, p= 0.74). After adjusting for demographic-clinical covariates in a hierarchical multiple regression, Amiodarone prophylaxis remained an independent predictor of shorter LOS (b= -2.3 [-3.7, -0.93], p= 0.001). Other independent predictors included: left atrial diameter of >40 mm (b= 1.7 [0.90, 2.85], p< 0.001), female sex (b= 1.4 [0.56, 2.19], p= 0.001), history of heart failure (b= 2.1 [0.94, 3.30], p< 0.001), and CVS involving VHS + CABG (b= 1.4 [0.15, 2.67], p= 0.03), and VHS + CABG + other (b= 5.1 [2.51, 7.72], p<0.001). Amiodarone prophylaxis is independently associated with significantly shorter LOS following CVS.

Molecular mechanisms of postoperative atrial fibrillation in patients with obstructive sleep apnea.

Obstructive sleep apnea (OSA) promotes atrial remodeling and fibrosis, providing a substrate for atrial fibrillation (AF). Herein, we investigate the pathophysiological mechanisms of AF in association with OSA in a cohort of cardiac surgery patients. A prospective study including patients undergoing cardiac surgery. Biomarkers reflective of AF pathophysiology (interleukin [IL-6], C-reactive protein [CRP], von Willebrand factor [vWF], N-terminal pro-brain natriuretic peptide [NT-proBNP], high-sensitivity Troponin T [hs-TnT], and Galectin-3 [Gal-3]) was assessed by functional or immunological assays. miRNAs involved in AF were analyzed by reverse transcription-polymerase chain reaction (RT-PCR). Using atrial tissue samples, fibrosis was assessed by Masson's trichrome. Connexin 40 and 43 (Cx40; Cx43) were evaluated by immunolabeling. Fifty-six patients (15 with OSA and 41 non-OSA) were included in this hypothesis-generating pilot study. OSA group had a higher incidence of postoperative AF (POAF) (46.7% vs. 19.5%; p = .042), presented an increased risk of POAF (OR 3.61, 95% CI 1.01-12.92), and had significantly higher baseline levels of NT-proBNP (p = .044), vWF (p = .049), Gal-3 (p = .009), IL-6 (p = .002), and CRP (p = .003). This group presented lower levels of miR-21 and miR-208 (both p < .05). Also, lower Cx40 levels in POAF and/or OSA patients (50.0% vs. 81.8%, p = .033) were found. The presence of interstitial fibrosis (according to myocardial collagen by Masson's trichrome) was raised in OSA patients (86.7% vs. 53.7%, p = .024). Several biomarkers and miRNAs involved in inflammation and fibrosis were dysregulated in OSA patients, which together with a higher degree of interstitial fibrosis, altered miRNA, and Cxs expression predisposes to the development of a substrate that increases the AF risk.

Prediction of new onset postoperative atrial fibrillation using a simple Nomogram

BackgroundNew onset postoperative atrial fibrillation (POAF) is the most common complication of cardiac surgery, with an incidence ranging from 15 to 50%. This study aimed to develop a new nomogram to predict POAF using preoperative and intraoperative risk factors.MethodsWe retrospectively analyzed the data of 2108 consecutive adult patients (> 18 years old) who underwent cardiac surgery at our medical institution. The types of surgery included isolated coronary artery bypass grafting, valve surgery, combined valve and coronary artery bypass grafting (CABG), or aortic surgery. Logistic regression or machine learning methods were applied to predict POAF incidence from a subset of 123 parameters. We also developed a simple nomogram based on the strength of the results and compared its predictive ability with that of the CHA2DS2-VASc and POAF scores currently used in clinical practice.ResultsPOAF was observed in 414 hospitalized patients. Logistic regression provided the highest area under the receiver operating characteristic curve (ROC) in the validation cohort. A simple bedside tool comprising three variables (age, left atrial diameter, and surgery type) was established, which had a discriminative ability with a ROC of 0.726 (95% CI 0.693–0.759) and 0.727 (95% CI 0.676–0.778) in derivation and validation subsets respectively. The calibration curve of the new model was relatively well-fit (p = 0.502).ConclusionsLogistic regression performed better than machine learning in predicting POAF. We developed a nomogram that may assist clinicians in identifying individuals who are prone to POAF.

Effectiveness of pharmacological cardioversion of new-onset atrial fibrillation during thoracic surgery operations: a single-centre experience

ObjectiveProphylactic pharmacological conversion agents could reduce the incidence of postoperative atrial fibrillation (AF) in patients undergoing thoracic operations. The current study examined whether the use of pharmacological conversion agents could help to restore sinus rhythm in patients with AF newly developed during thoracic operations.MethodsMedical records of 18,605 patients from January 1, 2015 to December 31, 2019, at the Shanghai Chest Hospital were reviewed. Patients with non-sinus rhythm prior to the surgery (n = 128) were excluded from data analysis. The final analysis included 18,477 patients (n = 16,292 undergoing lung operations; n = 2,185 undergoing esophageal operations).ResultsIntraoperative AF (defined as AF lasting for at least 5 min) occurred in 646 out of a total of 18,477 subjects (3.49%). Within the 646 subjects, 258 received pharmacological conversion agents during the surgery. sinus rhythm was restored in 20.15% (52/248) of patients treated with pharmacological cardioversion and in 20.87% (81/399) patients not receiving pharmacological intervention. In a subgroup analysis of the 258 patients receiving pharmacological conversion agents, recovery of sinus rhythm was highest in beta-blocker group (35.59%, 21/59 vs. 15.78%, 15/95 in amiodarone group, p = 0.008, 5.55%, and 1/18 in amiodarone plus beta-blockers group, p = 0.016). The incidence of hypotension was higher in pharmacological conversion (27.5% vs. 9.3% in patients not receiving pharmacological intervention, p < 0.001). In subjects not recovering to sinus rhythm during the surgery (n = 513), electrical cardioversion in post-anesthesia care unit (PACU) restored sinus rhythm in > 98% of the cases (155/158 vs. 63/355 in subjects not receiving cardioversion; p < 0.001).ConclusionsOur experience shows that pharmacological conversion, in general, failed to show better treatment effectiveness on intraoperative new-onset AF within period of surgery except for beta-blockers. Patients with AF persisting beyond the surgery could be effectively managed with electrical cardioversion.

Hematopoietic Somatic Mosaicism Is Associated With an Increased Risk of Postoperative Atrial Fibrillation.

On-pump cardiac surgery triggers sterile inflammation and postoperative complications such as postoperative atrial fibrillation (POAF). Hematopoietic somatic mosaicism (HSM) is a recently identified risk factor for cardiovascular diseases and results in a shift toward a chronic proinflammatory monocyte transcriptome and phenotype. The aim of this study was to assess the prevalence, characteristics, and impact of HSM on preoperative blood and myocardial myeloid cells as well as on outcomes after cardiac surgery. Blood DNA from 104 patients referred for surgical aortic valve replacement (AVR) was genotyped using the HemePACT panel (576 genes). Four screening methods were applied to assess HSM, and postoperative outcomes were explored. In-depth blood and myocardial leukocyte phenotyping was performed in selected patients using mass cytometry and preoperative and postoperative RNA sequencing analysis of classical monocytes. The prevalence of HSM in the patient cohort ranged from 29%, when considering the conventional HSM panel (97 genes) with variant allelic frequencies≥2%, to 60% when considering the full HemePACT panel and variant allelic frequencies≥1%. Three of 4 explored HSM definitions were significantly associated with higher risk for POAF. On the basis of the most inclusive definition, HSM carriers exhibited a 3.5-fold higher risk for POAF (age-adjusted OR: 3.5; 95%CI: 1.52-8.03; P=0.003) and an exaggerated inflammatory response following AVR. HSM carriers presented higher levels of activated CD64+CD14+CD16- circulating monocytes and inflammatory monocyte-derived macrophages in presurgery myocardium. HSM is frequent in candidates for AVR, is associated with an enrichment of proinflammatory cardiac monocyte-derived macrophages, and predisposes to a higher incidence of POAF. HSM assessment may be useful in the personalized management of patients in the perioperative period. (Post-Operative Myocardial Incident & Atrial Fibrillation [POMI-AF]; NCT03376165).

Observation of Post-Operative Support among LAVI and AF after MVR in Patients with Mitral Valve Disease

Introduction: Mitral valve disease is a common heart condition that may require mitral valve replacement (MVR) surgery. One of the potential complications after MVR is the development of atrial fibrillation (AF). Left atrial volume index (LAVI) is a measure of left atrial size that has been linked to the development of AF in patients with mitral valve disease. The present study aimed to observe the post-operative support needed by patients after MVR surgery, particularly those with elevated LAVI and the incidence of post-operative AF. Methods: This prospective observational study was conducted at the Department of Cardiac Surgery, National institute of cardiovascular diseases (NICVD), Sher-e-Bangla Nagar, Dhaka, Bangladesh. The study duration was 1 year, from Mar, 2018 to Feb, 2019. During this period, a total of 60 patients who underwent Mitral Valve Replacement (MVR) for mitral valve diseases at the study hospital were included in the study following the inclusion and exclusion criteria through a purposive sampling method. The 60 patients were divided in two equal groups, Group A, consisting of 30 Patients who had Left Atrial Volume Index of ≥ 39 ml/m2 after operation, while group B had been comprised of 30 patients who had Left Atrial Volume Index of &lt; 39 ml/m2 after operation. Result: Around 23.33% of participants in both groups were aged 21-30, while 40% of Group A and 36.66% of Group B were aged 31-40. In terms of BMI, 53.33% of Group A and 46.66% of Group B had a normal BMI, while 40% and 43.33% were overweight, and 6.66% and 10% were obese, respectively. Specifically, 23.33% of participants in Group A developed post-operative AF, while only 6.66% of participants in Group B developed it. The p-value for this comparison was 0.015. The results demonstrate that Group B had significantly smaller LA diameter, LA volume, LAVI, LVIDS, and LV ejection fraction compared to Group A at all three measurements post-operation (p&lt;0.05). However, there was no significant ...

Effects of postoperative atrial fibrillation on cardiac surgery outcomes in Vietnam: a prospective multicenter study

ABSTRACT Background This study was designed to assess the impact of postoperative atrial fibrillation (POAF) on short- and long-term outcomes after cardiac surgery. Methods We prospectively assessed POAF concerning outcomes in 379 adult patients who had undergone cardiac surgery in two heart surgery centers with a follow-up period of one year for every patient. The effects of POAF on postoperative events were evaluated using Logistic regression, Cox regression (adjusted for propensity score), and Kaplan-Meier analysis. Results The incidence of POAF was 27.2%. Multivariable logistic regression analysis revealed POAF was associated with an increased risk of 6-month (OR = 5.36; CI: 1.51–18.94; p = 0.009), and 1-year mortality (OR = 4.56; CI: 1.29–16.04; p = 0.018) as well as Major Adverse Cardiocerebral Events (MACEs; acute MI, cardiac arrest, low cardiac output after surgery, third-degree atrioventricular block or stroke; OR = 3.02; CI: 1.29–7.05; p = 0.011), Intensive Care Unit (ICU) stay > 3 days (OR = 2.39; CI: 1.14–5.00; p = 0.021), and postoperative stay > 14 days (OR = 3.12; CI: 1.65–5.90; p < 0.001). Multivariable Cox regression analysis showed POAF as an independent predictor of mortality at one year (HR = 2.86; CI: 1.05–7.75; p = 0.038). Discharge plans including statin and beta-blocker had an independent association with a reduced mortality at one year (HR = 0.22; CI: 0.05–0.96; p = 0.045; HR = 0.16; CI: 0.03–0.87; p = 0.034, respectively). Conclusions POAF is associated with an increased risk of morbidity, all-cause mortality, and hospital duration. Statins and beta-blockers that were included in discharge plans had an independent association with reduction in 1-year all-cause mortality.

Association between obstructive sleep apnea and atrial fibrillation and delirium after cardiac surgery. Sub-analysis of DECADE trial

BackgroundAtrial fibrillation and delirium are common complications after cardiac surgery. Both are associated with increased Intensive Care Unit (ICU) and hospital length of stay, functional decline, 30-day mortality and increase in health care costs. Obstructive Sleep Apnea (OSA) induces deleterious effects in the cardiovascular and nervous systems. We hypothesized that adult patients with preoperative OSA have a higher incidence of postoperative atrial fibrillation and delirium than patients without OSA, after cardiac surgery. MethodsSub-analysis of the DECADE trial at Cleveland Clinic hospitals. Our exposure was OSA, defined by STOP-BANG questionnaire score higher than 5 and/or a preoperative diagnosis of OSA. The primary outcome was atrial fibrillation, defined by clinician diagnosis or documented arrhythmia. The secondary outcome was delirium assessed twice during the initial five postoperative days using the Confusion Assessment Method for ICU. We assessed the association between OSA, and atrial fibrillation and delirium using a logistic regression model adjusted for confounders using inverse probability of treatment weighting. Results590 patients were included in the final analysis. 133 were diagnosed with OSA and 457 had no OSA. Satisfactory balance between groups for most confounders (absolute standardized difference < 0.10) was achieved after weighting. The atrial fibrillation incidence was 37% (n = 49) in the patients with OSA and 33% (n = 150) in the non-OSA patients. OSA was not associated with atrial fibrillation with an estimated odds ratio of 1.22 (95% CI: 0.75,1.99;p = 0.416). The delirium incidence was 17% (n = 22) in patients with OSA and 15% (n = 67) in the non-OSA patients. OSA was not associated with delirium with an estimated odds ratio of 0.93 (95% CI: 0.51,1.69;p = 0.800). ConclusionIn adult patients having cardiac surgery, OSA is not associated with a higher incidence of postoperative atrial fibrillation and delirium. These results suggest different prominent factors rather than OSA affect the incidence of these postoperative outcomes.

Randomized feasibility trial of prophylactic radiofrequency ablation to prevent atrial fibrillation after cardiac surgery

ObjectiveTo evaluate the feasibility of prophylactic radiofrequency isolation of the pulmonary veins, with left atrial appendage amputation, to reduce the incidence of postoperative atrial fibrillation after cardiac surgery in patients aged 70 years and older. MethodsThe Federal Food and Drug Administration granted an investigational device exemption to utilize a bipolar radiofrequency clamp for prophylactic pulmonary vein isolation in a limited feasibility trial. Sixty-two patients without prior dysrhythmias were prospectively randomized to undergo either their index cardiac surgical procedure or bilateral pulmonary vein isolation and left atrial appendage amputation during their cardiac operation. The primary outcome was occurrence of in-hospital postoperative atrial fibrillation. Subjects were on 24-hour telemetry until discharge. Dysrhythmias, any episode of atrial fibrillation >30 seconds, were confirmed by electrophysiologists blinded to the study. ResultsSixty patients, mean age 75 years and mean Congestive heart failure, Hypertension, Age (>65 = 1, >75 = 2 points), Diabetes, previous Stroke/Transient ischemic attack (2 points), Vascular disease, Gender (female) score of 4, were analyzed. Thirty-one patients randomized to control and 29 to the treatment group. The majority of patients in each group underwent isolated coronary artery bypass grafting. No perioperative complications related to the treatment procedure, need for permanent pacemaker, or mortality occurred. The in-hospital incidence of postoperative atrial fibrillation was 55% (17 out of 31) in the control group and 7% (2 out of 29) in the treatment group (P < .001) The control group had a significantly higher requirement for antiarrhythmic medications at discharge: 45% (14 out of 31) versus 7% (2 out of 29) in the treatment group (P < .001). ConclusionsProphylactic radiofrequency isolation of the pulmonary veins with left atrial appendage amputation during the primary cardiac surgical operation reduced the incidence of postoperative atrial fibrillation in patients aged 70 years and older with no history of atrial arrhythmias.

A study of the effects of intravenous magnesium sulphate on post-operative atrial fibrillation in patients undergoing off pump coronary artery bypass grafting (CABG)

Atrial fibrillation (AF) occurs in almost 30% of patients undergoing coronary artery bypass grafting (CABG). Around 80% of these patients have decreased levels of total and ionized serum magnesium postoperatively. The association between magnesium deficiency and post CABG AF is still undetermined. Therefore, a large variety of prophylactic strategies have been assessed including perioperative magnesium administration. However, the efficacy is still questionable. The aim of this study was to find out any correlation of serum magnesium levels with the incidence of post-operative atrial fibrillation in patients undergoing off pump CABG and whether magnesium supplementation modifies the incidence. One hundred fifty patients undergoing CABG were selected and divided into treatment and control groups. Perioperative serum magnesium assays were done, and patients were monitored in the postoperative period for occurrence of Atrial Fibrillation. The risk of post CABG atrial fibrillation was more among females, obese patients, patients with EF &amp;#60; 50% and RWMA. Post-operative AF occurred in 5 patients in the treatment group (n = 75) and 11 patients in the control group (n = 75). : The proportion of patients with post-operative atrial fibrillation among cases (6.7%) was lower than that of controls (14.7%) which may indicate an important role of magnesium in prevention of AF following cardiac surgeries. The results however didn’t reach a statistical significance which could be due to sample size, the duration and design of the study and the period of post-operative AF monitoring.

Association of postoperative atrial fibrillation with higher dosing ratios of protamine-to-heparin.

Background: Postoperative atrial fibrillation (POAF) is defined as new-onset AF in the immediate postoperative period. The relatively high incidence of POAF after cardiac surgery is well described, but pathophysiological mechanisms underlying the initiation, maintenance, and progression of POAF may be multifactorial and have not yet been comprehensively characterized. One of the mechanisms includes altered Ca2+ kinetics. Accumulating evidence has suggested that altered atrial cytosolic calcium handling contributes to the development of POAF, protamine reversibly modulates the calcium release channel/ryanodine receptor 2 (RyR2) and voltage-dependent cardiac RyR2. However, it is currently unknown whether such abnormalities contribute to the arrhythmogenic substrate predisposing patients to the development of POAF. Methods: We have retrospectively analyzed 147 patients who underwent cardiac surgery with cardiopulmonary bypass support. Of these, 40 patients were excluded from the analysis because of pre-existing AF. All patients received heparin followed by protamine at different dosing ratios of protamine-to-heparin, depending on the periods studied. Results: The dosing ratio of protamine-to-heparin=1.0 was compared with higher dosing ratios of protamine-to-heparin >1.0 up to 1.7. POAF developed in 15 patients (15/107=14%), of these, 5 out of 57 patients (33.3%) in the dosing ratio of protamine-to-heparin=1.0 and 10 out of 35 patients (66.7%) in the higher dosing ratios of protamine-to-heparin. Statistical significance was observed in patients with higher dosing ratios of protamine-to-heparin, compared with the dosing ratio of protamine-to-heparin=1.0 (odds ratio=3.890, 95% CI=1.130-13.300, p-value=0.031). When types of diseases were analyzed in terms of higher dosing ratios of protamine-to-heparin, only valvular disorders were significantly associated with POAF (p=0.04). Conclusions: Protamine is clinically utilized to reverse heparin overdose and has been shown to display immunological and inflammatory alterations. However, its association with POAF has not been reported. Our results provide evidence that higher dosing ratios of protamine-to-heparin may increase the incidence of POAF.

Efficacy of tolvaptan in postoperative volume therapy for acute Stanford type A aortic dissection

BackgroundDespite the increasing application of tolvaptan in cardiac surgery, there is no information on the use of tolvaptan in Stanford patients with type A aortic dissection. This study aimed to evaluate the postoperative clinical effects of tolvaptan in patients with type A aortic dissection after tafter surgery.MethodsA retrospective analysis was performed on 45 patients treated for type A aortic dissection in our hospital from 2018 to 2020. These included 21 patients who were treated with tolvaptan (Group T) and 24 patients who received traditional diuretics (Group L). The hospital's electronic health records were used to obtain perioperative data.ResultsGroup T did not differ significantly from Group L in terms of the duration of mechanical ventilation, postoperative blood required, length of catecholamine use, or the amount of intravenous diuretic drugs administered (all P > 0.05). The development of postoperative atrial fibrillation was significantly less in the tolvaptan group (P = 0.023). The urine volumes and change in body weight loss were slightly higher in group T than in group L but the differences were non-significant (P > 0.05). Serum potassium, creatinine, and urea nitrogen levels did not differ between the groups in the week after surgery, At the same time, sodium was significantly higher in the Group T group on day 7 after transfer from the ICU (P = 0.001). In Group L, sodium levels were also elevated by day 7 (P = 0.001). On days 3 and 7, serum creatinine and urea nitrogen levels increased in both groups (both P < 0.05).ConclusionsBoth tolvaptan and traditional diuretics were found to be effective and safe for patients with acute Stanford type A aortic dissection. Moreover, tolvaptan may be associated with reducing the incidence of postoperative atrial fibrillation.

Comparison of in-hospital outcomes after coronary artery bypass graft surgery in elders and younger patients: a multicenter retrospective study

ObjectivesWe aimed to identify in-hospital outcomes in young (≤ 65 years) and old (> 65 years) patients after coronary artery bypass grafting (CABG) by analyzing the effect of age on adverse events after on-pump or off-pump CABG.MethodsPatients older than 65 years were defined as older patients and others were defined as younger patients. The qualitative data were compared by chi-square or Fisher's exact tests. The quantitative data were compared by the two-sample independent t-test or Mann–Whitney U test. Multifactor binary logistic regression was used to control for confounders and to investigate the effect of age on dichotomous outcome variables such as death.ResultsIn the on-pump CABG population, the postoperative in-hospital mortality, the incidence of postoperative symptomatic cerebral infarction (POSCI) and postoperative atrial fibrillation (POAF) was higher in older patients than in younger patients (P value < 0.05), and age > 65 years was associated with postoperative in-hospital mortality (OR = 2.370, P value = 0.031), POSCI (OR = 5.033, P value = 0.013), and POAF (OR = 1.499, P value < 0.001). In the off-pump CABG population, the incidence of POAF was higher in older patients than in younger patients (P value < 0.05), and age > 65 years was associated with POAF (OR = 1.392, P value = 0.011).ConclusionIn-hospital outcomes after CABG are strongly influenced by age. In on-pump CABG, the risk of postoperative death, POSCI, and POAF was higher in older patients, and in off-pump CABG, the risk of POAF was higher in older patients.

Investigation of the effect of postoperative early-term high-flow oxygen use on new-onset atrial fibrillation in high-risk patient groups after isolated coronary artery bypass graft operations.

Postoperative atrial fibrillation (PoAF) is a significant complication that may occur after coronary artery bypass graft (CABG) surgeries. High-flow nasal oxygen (HFNO) therapy has recently been used in adult patients. In this current study, we aimed to investigate the effect of early HFNO treatment after extubation on the development of postoperative atrial fibrillation, in patient groups at risk for PoAF. Patients who underwent isolated CABG surgery in our clinic between October 2021 and January 2022 and had a preoperative HATCH score of above 2, were retrospectively included in this study. After the extubation, patients who were followed-up with HFNO were defined as Group 1, and patients who were followed-up with a standard oxygen treatment were determined as Group 2. Group 1 consisted of thirty-seven patients with a median age of 56 (ranging between 37 and 75) years, while Group 2 had seventy-one patients with a median age of 58 (ranging between 41 and 71) years (p=0.357). The groups were similar in terms of gender, hypertension, diabetes mellitus, hypercholesterolemia, smoking, body mass index, and ejection fraction. The need for positive inotropic support and incidence of PoAF was significantly higher in Group 2 (p=0.022, p=0.017, respectively). In this study, we showed that HFNO treatment can reduce the rates of PoAF in high-risk patient groups.

Postoperative Atrial Fibrillation After Coronary Bypass Surgery In Patients Having Pre-Operative Hypoalbuminemia.

Hypoalbuminemia commonly occurs in cardiac patients, especially in elderly patients and those with chronic congestive heart failure, and it has been associated with adverse events such as atrial fibrillation. The study aimed to determine the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass surgery (CABG) with pre-operative hypoalbuminemia in a major cardiac surgery institute in Karachi, Pakistan. This descriptive cross-sectional study included patients of any gender, aged between 30-80 years, who underwent CABG surgery and had hypoalbuminemia at the time of pre-operative assessment. Hypoalbuminemia was defined as a serum albumin level less than 3.8 mg/dL (normal range: 3.8-4.5 mg/dL). We recorded routine daily 12-lead ECGs and monitored the occurrence of POAF within 72 hours of surgery. A total of 144 patients were included in the study, of which 77.8% (112) were male, and the mean age was 58.1±8.4 years. The average serum albumin levels before surgery were 3.5±0.2 mg/dL. The majority of patients, 71.5% (103), had three-vessel disease (3VD), and 20.8% (30) had 3VD with left main (LM) disease. Hypertension was observed in 70.1% (101) of the patients, diabetes in 52.1% (75), and prolonged CBP time in 61.8% (89). The frequency of POAF was 10.4% (15), and it was significantly higher in non-hypertensive and non-diabetic patients, with a crude odds ratio of 4.19 [1.39-12.65] and 8.47 [1.84-39.09], respectively. The study found that approximately one in every ten patients undergoing CABG experienced POAF. Surprisingly, the rate of POAF was higher among non-hypertensive and non-diabetic patients.

Assessment of preoperative anxiety and depression in patients with pulmonary ground-glass opacities: Risk factors and postoperative outcomes.

A large number of patients with pulmonary ground-glass opacities (GGOs) have anxiety and depression. However, the contributing factors and effects of anxiety and depression on postoperative outcomes are still unclear. Clinical data for patients undergoing surgical resection for pulmonary GGOs were collected. We prospectively evaluated levels and risk factors for anxiety and depression in patients with GGOs before surgery. The relationship between psychological disorders and postoperative morbidity was evaluated. Quality of life (QoL) was also assessed. A total of 133 patients were enrolled. Prevalence rates of preoperative anxiety and depression were 26.3% (n = 35) and 18% (n = 24), respectively. Multivariate analysis revealed depression [odds ratio(OR) = 16.27, p < 0.001] and multiple GGOs (OR = 3.146, p = 0.033) to be risk factors for preoperative anxiety. Anxiety (OR = 52.166, p < 0.001), age > 60 (OR = 3.601, p = 0.036), and unemployment (OR = 8.248, p = 0.006) were identified as risk factors for preoperative depression. Preoperative anxiety and depression were associated with lower QoL and higher postoperative pain scores. Our results also revealed that the incidence of postoperative atrial fibrillation was higher in patients with than in those without anxiety. In patients with pulmonary GGOs, comprehensive psychological assessment and appropriate management are required before surgery to improve QoL and reduce postoperative morbidity.

Obesity is associated with postoperative outcomes in patients undergoing cardiac surgery: a cohort study

BackgroundThe purpose of present study was to determine whether obesity was associated with increased adverse outcomes after cardiac surgery.MethodsThis is a retrospective cohort study from a large international database called the Medical Information Mart for Intensive Care III (MIMIC-III). Patients who underwent cardiac surgery and greater than 18 years old were divided into either nonobese (BMI < 30 kg/m2) or obese (BMI ≥ 30 kg/m2). The primary outcome of this study was 28-day mortality from the date of operation. Secondary outcomes included ICU mortality, 1-year mortality, incidence of postoperative atrial fibrillation (POAF), hospital length of stay (HOS_LOS) and ventilation-free days within 28 days (VFD_28).ResultsMultivariate logistic regression analysis revealed a negative effect of obesity on 28-day mortality, with an adjusted odds ratio (OR) of 1.57 (95% CI 1.14–2.16; p = 0.005). The association remained significant when PSM analysis and double robust analysis with all covariates were performed. In terms of 28-day mortality, the mediating effect of longer ventilation duration on obese patients was noticeable, and the proportion of the effect mediated was 8.2% (95% CI 2.1–25.5%; p = 0.012).ConclusionsAmong patients with cardiac surgery, obesity is associated with higher 28-day mortality. The longer ventilation duration may have mediated this effect. In future, considering the elevated incidence of the obese patients undergoing cardiac surgery, obesity stat should be included as one of the predictive variables for stratification of perioperative death risk.

Predictive nomogram for postoperative atrial fibrillation in locally advanced esophageal squamous carcinoma cell with neoadjuvant treatment.

Neoadjuvant therapy following minimally invasive esophagectomy is recommended as the standard treatment for locally advanced esophageal squamous carcinoma cells (ESCC). Postoperative atrial fibrillation (POAF) after esophagectomy is common. We aimed to determine the risk factors and construct a nomogram model to predict the incidence of POAF among patients receiving neoadjuvant therapy. We retrospectively included patients with ESCC receiving neoadjuvant chemotherapy (nCT), neoadjuvant chemoradiotherapy (nCRT), or neoadjuvant immunochemotherapy (nICT) following minimally invasive esophagectomy (MIE) for analysis. Patients without a history of AF who did not have any AF before surgery and who developed new AF after surgery, were defined as having POAF. We applied a LASSO regression analysis to avoid the collinearity of variables and screen the risk factors. We then applied a multivariate regression analysis to select independent risk factors and constructed a nomogram model to predict POAF. We used the receiver operating characteristic (ROC) curve, calibration curve, and decision curve analysis (DCA) curve to evaluate the nomogram model. A total of 202 patients were included for analysis, with 35 patients receiving nCRT, 88 patients receiving nCT, and 79 patients receiving nICT. POAF occurred in 34 (16.83%) patients. There was no significant difference in the distribution of neoadjuvant types between the POAF group and the no POAF group. There was a significant increase in postoperative hospital stay (p = 0.04), hospital expenses (p = 0.01), and comprehensive complication index (p < 0.001). The LASSO analysis screened the following as risk factors: blood loss; ejection fraction (EF); forced expiratory volume in 1 s; preoperative albumin (Alb); postoperative hemoglobin (Hb); preoperative Hb; hypertension; time to surgery; age; and left atrial (LA) diameter. Further, preoperative Alb ≤41.2 g/L (p < 0.001), preoperative Hb >149 g/L (p = 0.01), EF >67.61% (p = 0.008), and LA diameter >32.9 mm (p = 0.03) were determined as independent risk factors of POAF in the multivariate logistic analysis. The nomogram had an area under the curve (AUC) of 0.77. The Briser score of the calibration curve was 0.12. The DCA confirmed good clinical value. Preoperative Alb ≤41.2 g/L, LA diameter >32.9 mm, preoperative Hb >149 g/L, and EF >67.61% were determined as the risk factors for POAF among patients with ESCC. A novel and valuable nomogram was constructed and validated to help clinicians evaluate the risk of POAF and take personalized treatment plans.