The Impact Of Myocardial Protection Technique On The Incidence Of -post Coronary Bypass- Atrial Fibrillation/flutter
Ayman Kenawy, Laura Howell, David Rose, Mohamed N. Bittar, Antony Walker, Andrew Duncan, Josef Zacharias, Amal Bose, Mohamed N. Bittar.
Blackpool Victoria Hospital, Blackpool, United Kingdom.
OBJECTIVE: To determine whether any of the myocardial protection techniques is a factor that influence the incidence of post-operative AF/Flutter
METHODS: A single centre retrospective study of 3614 patients who underwent an isolated on-pump CABG using different myocardial protection strategies, inclusion criteria all CABG who were in Sinus rhythm pre operatively. Patient who had combined procedures or were in AF or paced rhythm were excluded. Patients were categorized into two groups: Group 1: cardioplegia group Group 2: cross- clamp and fibrillation Statistical analysis Comparisons between groups were made using a Chi-square test or Fisher’s exact test for categorical variables and using one-way ANOVA or Kruskal-Wallis for quantitative variables. Univariate logistic regression analysis was then performed to identify potential risk factors of post-operative AF/flutter. Potential confounding risk factors were then included in an adjusted multivariate logistic analysis
RESULTS: We identified 3614 patients in the period between 2004 to 2015 ; 2805 were in group 1 and 809 were in group 2. History of pulmonary disease & older age were significant potential predictors of post-operative AF (p=0.002, OR=1.40, 95% CI=1.13 to 1.73), (p=<0.001, OR=1.06, 95% CI= 1.05 to 1.07) respectively.On the contrary,cumulative cross clamp time and cumulative bypass time were not significant predictors of post-operative AF (p=0.285,p=0.470) respectively. In the cardioplegia group the incidence of AF in top ends on side clamp was not significantly different to single x-clamp surgery (OR=1.05, 95% CI=0.81 to 1.37, p=0.709) Group 2 patients (x-clamp and fibrillation technique) had higher incidence of developing post-operative AF which remained significantly high after adjusting to the history of pulmonary disease when compared with group 1 (OR=1.31, 95% CI=1.02 to 1.68, p=0.032), there was no significant difference in the age between the 2 groups also No significant differences were found in terms of the secondary outcomes mortality,CITU stay or post-operative length of stay.
CONCLUSIONS: Cross clamp fibrillation technique is associated with significantly higher incidence of AF. The history of pulmonary disease and age were strong predictors of postoperative AF
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