Incidence Of Postoperative Arrhythmias Research Articles

Hazardous alcohol consumption and perioperative complications in a cardiac surgery patient. A retrospective study.

We investigated the prevalence and effects of hazardous alcohol consumption on perioperative complications in cardiac surgery patients. Preoperative hazardous alcohol consumption has been associated with an increased risk of postoperative complications in noncardiac patient populations. We retrospectively collected data from the Finnish Intensive Care Consortium database and electronic patient records on all cardiac surgery patients treated in the intensive care units (ICUs) of Helsinki University Hospital (n = 919) during 2017. Data on preoperative alcohol consumption were routinely collected using the alcohol use disorder identification test consumption (AUDIT-C) questionnaire. We analyzed perioperative data and outcomes for any associations with hazardous alcohol consumption. Outcome measures were length of stay in the ICU, re-admissions to ICU, bleeding and infectious complications, and incidence of postoperative arrhythmias. AUDIT-C scores were available for 758 (82.5%) patients, of whom 107 (14.1%) fulfilled the criteria for hazardous alcohol consumption (AUDIT-C score of 5/12 or higher for women and 6/12 or higher for men). Patients with hazardous alcohol consumption were younger, median age 59 (IQR 52.0-67.0) vs. 69.0 (IQR 63.0-74.0), p < .001, and more often men 93.5% vs. 71.9%, p < .001 than other patients and had an increased risk for ICU re-admissions [adjusted OR (aOR) 4.37 (95% CI, 1.60-11.95)] and severe postoperative infections aOR 3.26 (95% CI, 1.42-7.54). Cardiac surgery patients with a history of hazardous alcohol consumption are younger than other patients and are predominantly men. Hazardous alcohol consumption is associated with an increased risk of severe postoperative infections and ICU re-admissions.

Incidence of new onset arrhythmia after non cardiac surgery

BACKGROUND Although new-onset arrhythmia are a common problem in cardiothoracic surgery, their incidence in major non- cardiac surgery has not been studied properly. The aim of the study is to assess the incidence of arrhythmia after non cardiac surgery. While we have some data on postop arrhythmia after general surgery, we don’t have much data on orthopedic surgery, and good proportion of our patient in the study belong to this category. Thus it is also aimed to compare the incidence of arrhythmia in different types of surgery.&#x0D; METHODOLOGY The present study is a retrospective cohort of 100 patients who recently underwent surgery between 2023 January 1st till 2023 June 1st. All included patients were monitored in ICU and post-operative ward after surgery. 100 patients (28 female and 72 male) without any history of prior arrhythmia were analyzed and included in the study. Incidence of postoperative arrhythmia (PA) was observed and compared in patients undergoing different types of surgery. Impact of age factor on the incidence of PA was also studied.&#x0D; RESULTS Incidence of overall PA among all patients were 31%. Incidence of significant PA were 14.3%. Incidence of significant PA was highest in gastro-surgery patients (22%) whereas orthopedics patients had 11% incidence of PA.&#x0D; CONCLUSION Gastro surgery seems to give high impact on incidence of PA. In our analysis, age of the patient appear to be associated with the causation of PA.

Implication to Prevent Tachyarrhythmia by Amiodarone Therapy During Durable Left Ventricular Assist Device Supports.

To the Editor: Graboyes et al.1 demonstrated that prophylactic amiodarone therapy was associated with a reduction in the incidence of postoperative arrhythmias, particularly atrial arrhythmias, without incremental incidence of amiodarone-related adverse events among those receiving durable continuous-flow left ventricular assist devices (CF-LVAD). Several concerns have been raised. The implication to prevent all postoperative tachyarrhythmias following CF-LVAD implantation is uncertain.1 Ventricular arrhythmias was not associated with in-hospital mortality and morbidity in patients receiving CF-LVAD supports in the US nationwide database.2 In another study conducted in Japan, the existence of atrial fibrillation was not associated with the development of hemocompatibility-related adverse events during CF-LVAD supports.3 On the contrary, the frequent low-flow alerts were managed by catheter ablation to treat ventricular tachyarrhythmias in a case report.4 It might be of great interest to investigate tachyarrhythmia-induced hemodynamic deterioration as a primary outcome. The definition of prophylactic treatment is unclear. In the authors’ study, some patients had history of arrhythmias and others received antiarrhythmic agents during CF-LVAD supports.1 The concomitant use of renin-angiotensin-aldosterone system inhibitors, which might also suppress the development of tachyarrhythmias, is unclear. The authors followed liver and thyroid function during amiodarone therapy for the safety analyses but did not investigate the incidence of interstitial pneumonia, which is one of the most fatal drug-related adverse events.1 How was associated biomarkers such as KL-6 and SP-D during amiodarone therapy? Although it did not reach statistical significance, more patients receiving amiodarone trended to encounter death or CF-LVAD exchange. Could the authors clarify the causes of their death?

One-shot cardioplegia for minimally invasive mitral valve repair-a comparison of del Nido and Bretschneider Histidine-Tryptophan-Ketoglutarate solutions.

Minimally invasive procedures are demanding in terms of cardioprotection. In many leading centres Bretschneider HTK solution is used for mitral valve surgery. The study was designed to provide comparison of the del Nido and Bretschneider HTK protocol. Patients who underwent minimally invasive mitral valve repair for primary mitral regurgitation and received single delivery of either del Nido (Group 1) or Bretschneider HTK cardioplegia (Group 2) were matched on basis of age, gender and length of the cross-clamp time. The groups were compared in terms of major adverse cardiac and cerebrovascular events (death, myocardial infarction, stroke), high sensitivity troponin T (hs-TnT) and creatine kinase- MB isoenzyme (CK-MB) release at 12h and 24h following the surgery, incidence of low cardiac output syndrome (LCOS), postoperative arrhythmia, transfusions and postoperative renal function. Case control matching selected 38 pairs of patients. None of patients died, nor suffered from myocardial infarction or stroke. Troponin values did not differ at 12h (median: 281.0pg/mL vs 313.0pg/mL; p = .38) and 24h (median: 261.0pg/mL vs 299.0pg/mL; p = .54), as well as CK-MB at 12h (median: 25.0ng/mL vs 29.0ng/mL; p = .31) and 24h (median: 11.0ng/mL versus 9.6ng/mL; p = .46). Difference in occurrence of LCOS was insignificant (2 vs 7; 5.2% vs 18.4%; p =.15). No difference was shown in incidence of postoperative arrhythmia, transfusions and renal function. Del Nido cardioplegia can be used safely as an alternative for Bretschneider HTK for minimally invasive mitral valve surgery.

Comparison of dexmedetomidine and meperidine for the prevention of shivering following coronary artery bypass graft: study protocol of a randomised controlled trial

IntroductionShivering is a common complication in the postoperative period. The incidence of shivering has been reported to range from 5% to 65% under general anaesthesia and as 33% during epidural...

Impact of obesity on post-operative arrhythmias after congenital heart surgery in children and young adults.

Obesity increases the risk of post-operative arrhythmias in adults undergoing cardiac surgery, but little is known regarding the impact of obesity on post-operative arrhythmias after CHD surgery. Patients undergoing CHD surgery from 2007 to 2019 were prospectively enrolled in the parent study. Telemetry was assessed daily, with documentation of all arrhythmias. Patients aged 2-20 years were categorised by body mass index percentile for age and sex (underweight <5, normal 5-85, overweight 85-95, and obese >95). Patients aged >20 years were categorised using absolute body mass index. We investigated the impact of body mass index category on arrhythmias using univariate and multivariate analysis. There were 1250 operative cases: 12% underweight, 65% normal weight, 12% overweight, and 11% obese. Post-operative arrhythmias were observed in 38%. Body mass index was significantly higher in those with arrhythmias (18.8 versus 17.8, p = 0.003). There was a linear relationship between body mass index category and incidence of arrhythmias: underweight 33%, normal 38%, overweight 42%, and obese 45% (p = 0.017 for trend). In multivariate analysis, body mass index category was independently associated with post-operative arrhythmias (p = 0.021), with odds ratio 1.64 in obese patients as compared to normal-weight patients (p = 0.036). In addition, aortic cross-clamp time (OR 1.007, p = 0.002) and maximal vasoactive-inotropic score in the first 48 hours (OR 1.03, p = 0.04) were associated with post-operative arrhythmias. Body mass index is independently associated with incidence of post-operative arrhythmias in children after CHD surgery.

EFFECT OF PROPOFOL IN CARDIOPLEGIA SOLUTION ON BIOMARKERS OF MYOCARDIAL INJURY IN CORONARY ARTERY BYPASS GRAFTING SURGERY: A RANDOMIZED DOUBLE-BLIND CLINICAL TRIAL

Introduction: Coronary artery bypass graft (CABG) surgery with cardiopulmonary bypass (CPB) triggers an inflammatory reaction, leading to the development of myocardial damage and dysfunction. It is assumed that propofol, a general anesthetic agent, has a protective role against oxidative stress. The aim of this study was to evaluate the effect of propofol on myocardial protection when added to cardioplegic solution in patients undergoing CABG. Methods: In this prospective and double-blind RCT study, 120 patients undergoing CABG surgery were randomly assigned into two equal groups. In one group, we added 1200 µg/min (ultimate dose 4 µg/ml) propofol to cardioplegic solution and in the control group, an equal volume of normal saline was added to cardioplegic solution. Serum levels of CPK-MB and Troponin I were checked at four time points, including: just after induction (T1) as baseline, after chest closure (T2), 6 hours after arrival to ICU (T3) and 24 hours after ICU admission (T4). Results: Cardiac enzyme levels had significant increase over time in both groups (p-value &lt;0.05). It was observed that the enzyme levels in the propofol group increased less compared with the control group; however, this difference was not significant. Both groups were also similar in incidence of post-operative arrhythmia and need for use of IABP. Conclusion: Adding a dose of 1200 µg/min (ultimate dose 4 µg/mL) propofol to cardioplegia solution does not have an effect on CPK-MB &amp; troponin I level.

Effect of Del Nido cardioplegia on ventricular arrhythmias after cardiovascular surgery

BackgroundDel Nido cardioplegia (DNC) has been proven safe and effective in pediatric patients. However, the use of DNC in adult undergoing cardiovascular surgery lacks support with substantial evidence. This study aimed to evaluate the efficacy of DNC as a cardioplegia of prophylaxis to ventricular arrhythmias associated to cardiovascular surgery in adult patients.MethodsThis study recruited nine hundred fifty-four patients who underwent cardiopulmonary bypass surgeries in Nanjing Hospital affiliated to Nanjing Medical University between January 2019 and December 2019. Among 954 patients, 324 patients were treated with DNC (DNC group), and 630 patients were treated with St. Thomas cardioplegia (STH group). The incidence of postoperative arrhythmia as well as other cardiovascular events relavant to the surgery were investigated in both groups.ResultsIn DNC group, the incidence of postoperative ventricular arrhythmias was lower (12.4% vs. 17.4%, P = 0.040), and the length of ICU stay was shorter (1.97 ± 1.49 vs. 2.26 ± 1.46, P = 0.004). Multivariate logistic regression demonstrated that the use of DNC helped to reduce the incidence of postoperative ventricular arrhythmias (adjusted odds ratio 0.475, 95% CI 0.266–0.825, P = 0.010). The propensity score-based analysis and subgroup analysis indicated that DNC has the same protecting effects towards myocardial in all kinds of cardiopulmonary bypass surgeries.ConclusionsDel Nido cardioplegia may potentially reduce the incidence of postoperative ventricular arrhythmias, shorten the length of ICU stay and improve the overall outcome of the patients undergoing cardiovascular surgery.

Describing Clinically Significant Arrhythmias in Postoperative Vascular Surgery Patients

The American Heart Association guidelines instruct use of postoperative telemetry (POT) should be reserved for patients undergoing cardiac procedures and/or those with ischemic cardiac symptoms, but acknowledge that major vascular procedures deserve unique consideration. Telemetry remains a limited resource in many hospitals; however, it has been poorly defined which vascular patients have greatest need for POT. The purpose of this study is to define the rates of postoperative arrhythmias (POAs) after major vascular operations using the Society for Vascular Surgery Vascular Quality Initiative (VQI) registry, identify independent predictors of POA, and determine the effect of POA on mortality to guide the use of POT in vascular patients. A retrospective cohort study was performed using the following VQI modules: open abdominal aortic aneurysm repair (oAAA), complex endovascular aneurysm repair (EVAR) (thoracic endovascular aortic repair [TEVAR]/c-EVAR), EVAR, suprainguinal bypass (SIB), and infrainguinal bypass (IIB). POA was defined in the VQI as a new rhythm disturbance requiring treatment with medication or cardioversion. The incidence of POA, preoperative risk factors, and demographics were determined for each procedure. A total of 121,652 procedures were identified with an overall POA event rate of 5.1% (n=6,265). Procedure-specific event rates for POA among VQI registries are as follows: oAAA 14.4%, TEVAR/c-EVAR 8.5%, EVAR 2.7%, SIB 6.2%, and IIB 3.8%. Across all procedure types, POA was associated with emergent operations and increased procedure time. Procedure-specific multivariable regression revealed additional independent preoperative intraoperative factors associated with POA that were unique with each procedure. Across all procedural groups, the presence of POA was associated with increased rates of clinical myocardial infarction and decreased survival on Kaplan-Meier analysis. Rates of POA in patients undergoing vascular procedures appear higher than previously reported, and POA is associated with decreased survival. Our study elucidated patient- and procedure-specific predictor factors associated with POA that can be used to inform the use of POT.

Fontan procedure: Early outcomes of 87 consecutive patients in a tertiary care center.

Al Absi and colleagues report their early results of the Fontan procedure in 87 consecutive patients between August 2008 and July 2017 in a tertiary care hospital. The use of the intra/extracardiac fenestration is a promising modification because it is unlikely to be occluded by surrounding tissue and may be associated with decreased pleural effusions, length of hospital stay, and incidence of postoperative arrhythmias.

Effect of phase I cardiopulmonary rehabilitation on patients with coronary artery bypass grafting: a Meta-analysis

Objective To evaluate the rehabilitation effect of phase I cardiopulmonary rehabilitation on patients with coronary artery bypass grafting (CABG) . Methods Chinese and English databases were searched via computer including PubMed, Embase, Cochrane Library, Web of Science, CNKI, Wanfang, VIP, with the time set as the database establishment date to 31st January of 2019, to obtain randomized controlled trials of phase I cardiopulmonary rehabilitation in CABG. Meta-analysis of the included studies was performed by RevMan 5.3 software. Results A total of 8 studies were included, according to the Meta analysis, 6 min walking distance increased in the phase I cardiopulmonary rehabilitation patients group (MD=56.46, 95%CI 32.82-80.09, P 0.05) . Conclusions Phase I cardiopulmonary rehabilitation can improve the activity endurance, pulmonary function, shorten the hospitalization time and reduce the incidence of postoperative arrhythmia, but it can not significantly improve the quality of life. Due to the small number of included studies and the heterogeneity of some indicators, the results of this study still need to be verified by multicenter, large sample and high-quality randomized controlled trials. Key words: Meta analysis; Coronary artery bypass grafting; Coronary bypass; Phase I cardiopulmonary rehabilitation; Cardiac rehabilitation

Preoperative High Sensitivity C-reactive Protein Level Predicts Early Outcome After Coronary Artery By-pass Surgery

Background: Coronary artery bypass surgery (CABG) with cardioplegia has been considered the gold standard operation for coronary revascularization. Activation of compliments system after CABG surgery involves C-reactive protein (CRP). Patients with preoperative increased CRP levels have significantly higher CRP levels on postoperative days and are at increased risk of developing postoperative complications. High sensitivity CRP ( hs-CRP ) is lower concentration of CRP measured by the hs-CRP test. It is more sensitive and more useful in predicting the potential risk level for cardiovascular disease, heart attacks and strokes.&#x0D; Objective: To assess the association of preoperative hs-CRP level with the incidence of postoperative arrhythmia, low output syndrome and sternal wound infection following on pump CABG surgery.&#x0D; Materials &amp; Methods: The study was cross sectional analytical study. A total of 70 patients were selected. For the purpose of analysis the study subjects were divided into two group; Group A patients with preoperative hs-CRP level &lt;3mg/l (n=35) and Group B patients with preoperative hs-CRP level &gt;3mg/l (n=35). The incidence of early outcome- arrhythmia, low output syndrome and sternal wound infection were observed within 30 days of surgical procedure.&#x0D; Results: The incidence of arrhythmia, low output syndrome and sternal wound infection were significantly less in group A than those in group B. Logistic regression analysis showing significant correlation of hs-CRP with arrhythmia, p value is 0.005; with low output syndrome, p value is 0.003 and with sternal wound infection, p value is 0.004.&#x0D; Conclusion: Preoperative hs- CRP is an important determinant of post operative outcome after CABG surgery and might be useful as predictive marker in risk stratification for postoperative complications in patients scheduled for on pump CABG surgery.&#x0D; KYAMC Journal Vol. 9, No.-4, January 2019, Page 153-158

N-3 polyunsaturated fatty acids reduces post-operative atrial fibrillation incidence in patients undergoing “on-pump” coronary artery bypass graft surgery

The aim of this study was to evaluate the efficacy of preoperative and postoperative therapy with n-3 polyunsaturated fatty acids in reducing the incidence of atrial fibrillation after coronary artery bypass graft surgery. 201 patients undergoing coronary artery bypass graft surgery were randomized to 1) a control group (105 patients), or 2) n-3 polyunsaturated fatty acids 2 g/day group (96 patients) for at least 5 days before surgery and until hospital discharge. Groups were further subdivided in four subgroups according to the operative technique: "off-pump" or "on-pump". The primary end point was to evaluate the reduced incidence of postoperative in-hospital atrial fibrillation in the (N-3 PUFA) group. Secondary end points were the impact of the surgical technique on the incidence of postoperative arrhythmia and the impact of n-3 polyunsaturated fatty acids therapy on post-operative hospital length of stay. The overall incidence of post-operative atrial fibrillation was 17.4% (35/201). The arrhythmia occurred in 11.4% (11/96) of the patients in therapy with n-3 polyunsaturated fatty acids and in 22.8% (24/105) in the control groups. In particular, the statistical analysis of subgroups showed a significant reduction of postoperative atrial fibrillation only in the group including patients treated with n-3 polyunsaturated fatty acids undergoing "on-pump" coronary artery bypass graft surgery. The length of hospital stay did not differ among all groups. N-3 polyunsaturated fatty acids administration significantly reduces the incidence of post-operative atrial fibrillation in patients undergoing "on-pump" coronary artery bypass graft surgery. N-3 polyunsaturated fatty acids therapy is not associated with a shorter hospital stay.

Perspectives in ablation of arrhythmias in children and patients with congenital heart disease

Although most arrhythmias in children have a benign outcome, recurrent arrhythmic events have a significant impact on quality of life. Electrophysiology studies with ablation have good short-term success and an acceptably low complication rate. The long-term outlook for this patient group is incompletely defined, however. Factors that require special consideration in children include the need to limit the size, depth and number of lesions, and the radiation exposure incurred during fluoroscopy-guided catheters manipulation. The use of cryoablation seems promising in limiting lesion size. Three-dimensional (3D) mapping systems clearly have been shown to reduce the radiation dose. In congenital heart disease, these advances in technology have helped to further our understanding of the mechanisms underlying arrhythmias. It is anticipated that earlier intervention and newer operative techniques will reduce the incidence of postoperative arrhythmias in the future. For those patients who still develop tachyarrythmias after cardiac surgery, the use of three-dimensional systems and other new technologies permits more efficient intervention in the electrophysiology laboratory.

Editorial Comment: Corrected transposition of the great arteries: the continuing quest for the optimal surgical management

Hiramatsu et al. [1] have reported their experience with an anatomic repair of congenitally corrected transposition of the great arteries (ccTGA). This included 90 patients operated on between 1983 and 2010. Seventy-two patients with ccTGA, ventricular septal defect (VSD) and pulmonary stenosis underwent atrial switch plus intraventricular rerouting. Eighteen patients without pulmonary stenosis had atrial switch plus arterial switch. The long-term results were carefully evaluated. Differences between the two groups were noted. Patients without pulmonary stenosis (the double-switch group) had a better outcome at 20 years regarding survival (83% vs 76%, NS), freedom from reoperation (94% vs 78%, P < 0.05) or arrhythmia (79% vs 57%, P < 0.05). The total freedom from all cardiac events (death, reintervention or reoperation, arrhythmia) was significantly different (60% in the double-switch group vs 40% in the group with pulmonary stenosis). The functional outcome was similar in both groups and, overall, satisfactory. These results should, however, be taken with caution, because of the small number of patients in the double-switch group. Interestingly, the Birmingham group (another institution with a large experience in this field) has recently reported its own experience between 1991 and 2011 [2]. This included 45 patients with Rastelli-Senning repair and 68 patients with double-switch operation. The results at 10 years were somewhat different. Survival (84% in the double-switch group vs 77% in the Rastelli-Senning group) and freedom from reintervention (50% vs 49%) were similar in both groups. However, freedom from death, transplantation or heart failure was better in the Rastelli-Senning group. These results may seem contradictory. Actually, I think that they show only how difficult it is to draw out firm conclusions when so many factors are involved. ccTGA is a rare malformation; it is therefore difficult (actually impossible for any individual institution) to collect large cohorts of patients who undergo homogeneous surgical approaches. Very different patients are involved; patients with right ventricular dysfunction and severe tricuspid regurgitation because of Ebstein-like malformation are different from patients with a well-functioning right ventricle and a competent tricuspid valve; patients with an intact ventricular septum who need left ventricular retraining before undergoing a double-switch operation are different from patients with a large VSD and a left ventricle ready to sustain the systemic output. Different surgical options are available and may yield different results; regarding atrial switch, the Senning and Mustard operations or hemi-Mustard procedure with cavo-pulmonary anastomosis may influence the incidence of postoperative arrhythmias; reconstructing the right ventricular outflow tract with or without an extracardiac conduit may greatly modify the need for reoperation. Well-designed large multicentre cohort studies are necessary to address all these issues. Before such information is available, some considerations must be kept in mind:

Beating heart as an alternative for closure of secundum atrial septal defect

We repaired secundum atrial septal defect in 135 consecutive patients from February 2003 to December 2010. There were 98 females and 37 males, with a mean age of 22.92 ± 17.46 years (range, 3-55 years). To prevent myocardial dysfunction and systemic embolism caused by the conventional technique, the operation was performed with a beating heart under cardiopulmonary bypass in 63 cases, and compared the data retrospectively with cases treated under aortic crossclamping, to determine the safety of the beating-heart technique and to evaluate risk factors for embolism in stroke patients. Patient age and size of defect were similar in both groups. There was no death and no residual shunt in either group. The mean cardiopulmonary bypass time was 36.84 ± 9.8 min in the beating-heart group and 43.13 ± 16.7 min in the crossclamp group. The ejection fraction and the incidence of postoperative arrhythmia were similar in both groups. There were no differences in blood products transfused, intensive care unit stay, hospital stay, or perioperative morbidity. In our experience, the results of the beating-heart technique were not different from the conventional technique.

Right atrial and septal reconstruction after tumor excision: the single-patch technique

Surgical excision is the only therapy for benign atrial tumors, if serious complications are to be avoided. We propose a simplified technique whereupon a single autologous pericardial patch is used to not only close the septal defect, but to also reconstruct the right atrium. This new technique allows for wide excision of tumors without reduction of the right atrium, distortion of the tricuspid valve or traction on the atrioventricular node. We propose that this new approach will probably reduce the incidence of postoperative arrhythmias.

Analysis of arrhythmia for the patients of chest tumor after operation JIN Wen-bo,ZHANG Xiang-hua,

Objective To discuss the causes of postoperative arrhythmia patients with thoracic tumor and to explore the preventive and therapeutic measures.Methods A retrospective data of 551 patients with thoracic tumor was analyzed.Results There were 86 cases suffering postoperative arrhythmia,among which the incidence was 10.4% below 60 years old and 20.6% above.The incidence of those with preoperative cardiovascular diseases was 56.4%,of those with mediastinum tumor was 16.6%.The incidence of those with lung cancer was 12.5%,individually 20.5% for those receiving total pneumonectomy,10.6% for pulmonary lobectomy,and 8.5% for wedge-shape escision of lung.Of those with esophageal tumor the incidence was 23.5%,individually 22.0% for those receiving ccrvical anastomosis,and 15.3% for intrathoracic anastomosis Besides,the incidence of those with cardiac cancer was 20.1%.Conclusions Postoperative arrhythmia on patients with thoracic tumor is intimately correlated with the age,concurrent preoperative cardiovascular diseases,surgical methods and imraoperative conditions.It's feasible to prevent and reduce the incidence of postoperative arrhythmia by sufficient preoperative preparation,intensive postoperative custody and corrective anoxia. Key words: Thoracic neoplasms; Thoracic surgical procedures; Arrhythmia

Efficacy of Continuous Low-Dose hANP Administration in Patients Undergoing Emergent Coronary Artery Bypass Grafting for Acute Coronary Syndrome

Low-dose continuous human atrial natriuretic peptide (hANP) administration during cardiac surgery has been reported on previously. In the present study, the efficacy of the therapy during emergent coronary artery bypass grafting (CABG) for acute coronary syndrome (ACS) is investigated. One hundred and twenty-four patients patients undergoing emergent CABG for ACS were divided into 2 groups; a group receiving administration of hANP (hANP group) and a group not receiving hANP infusion (non-hANP group). The postoperative peak levels of creatine kinase-MB were significantly lower in the hANP group as compared with those in the non-hANP group. The incidence of postoperative arrhythmias was also significantly lower in the hANP group as compared with that in the non-hANP group. The postoperative brain natriuretic peptide was significantly lower in the hANP group as compared with that in the non-hANP group until 1 year after the operation. The free-rate of cardiac events after the operation was also significantly higher in the hANP group as compared with that in the non-hANP group. It is therefore considered that hANP might not only be effective for overcoming some major shortcomings of cardiopulmonary bypass, but also might be effective to attenuate ischemia-reperfusion injury, protect the myocardium, have an anti-arrhythmic effect, and suppress left ventricular remodeling.

Incidence and Types of Arrhythmias After Mediastinal Manipulation During Transhiatal Esophagectomy

Transhiatal esophagectomy (THE) is a common operative procedure for carcinoma esophagus. Complications of this procedure include arrhythmias and hypotension during blunt dissection of the esophagus from posterior mediastinum. In the literature, exact incidence and type of arrhythmias have not been reported. We employed Holter monitoring during mediastinal manipulation in patients undergoing THE, for this purpose. This prospective study was carried out in 20 consecutive American Society of Anesthesiologists grade I-II patients undergoing THE. Anesthetic technique included induction with thiopentone and maintenance with morphine, vecuronium, and isoflurane. In addition to routine parameters, Holter monitoring was undertaken to record the exact incidence and types of arrhythmias. "Premanipulation" or control period included duration of 30 minutes preceding mediastinal manipulation, while "during manipulation" or study period included the duration of mediastinal manipulation. The incidence of arrhythmias was studied for 48 hours in the postoperative period. The Fisher exact test was applied to analyze incidence of arrhythmias and hypotension. Out of 20 patients, only 2 had arrhythmias in the premanipulation period, while 13 had arrhythmias during the manipulation period (p < 0.01). During the manipulation period, arrhythmias included supraventricular ectopics and ventricular ectopics in 2 patients each and a combination of both in 9 patients. Arrhythmias were transient and had no correlation with either duration or degree of hypotension in all the patients. However, there was a linear relationship between hypotension and duration of mediastinal manipulation. Two patients (10%) had atrial arrhythmias in the postoperative period. In transhiatal esophagectomy, there is a significant incidence of both arrhythmias and hypotension during mediastinal manipulation. The incidence of arrhythmias can be minimized by limiting the duration of the manipulation. The incidence of postoperative arrhythmias was not significant.