Postcardiac Surgery Complications: Association of Acute Renal Dysfunction and Atrial Fibrillation

Albahrani, Maher J; Swaminathan, Madhav; Phillips-Bute, Barbara; Smith, Peter K.; Newman, Mark F.; Mathew, Joseph P.; Stafford‐Smith, Mark

doi:10.1213/01.ane.0000047886.81598.2c

Cited by 36 publications

(19 citation statements)

References 28 publications

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“…This finding is probably due to the high frequency of age-related structural changes such as degeneration of large-vessel elastin, increase in afterload, altered filling dynamics, atrial dilation, fibrosis, and electrical heterogeneity (10 -12,22). In keeping with results of prior studies (1,4,18), the occurrence of POAF was significantly associated with other post-operative complications. Diastolic dysfunction was likely a predisposing common denominator underlying these endpoints.…”

Section: Discussionsupporting

confidence: 89%

“…Several prior studies have analyzed predictors of POAF. However, many were subject to referral bias (1,4 -6), included patients with a history of AF (3)(4)(5), or confined their analysis to patients undergoing isolated CABG surgery (1,18,21), which limited a wider extrapolation of their findings. The risk factors identified in our population-based series predict the occurrence of POAF more accurately than those derived from more highly selected patient groups.…”

Section: Discussionmentioning

confidence: 99%

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Diastolic Dysfunction in Patients Undergoing Cardiac Surgery

Melduni

Suri

Seward

et al. 2011

Journal of the American College of Cardiology

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Section: Discussionsupporting

confidence: 89%

Section: Discussionmentioning

confidence: 99%

Diastolic Dysfunction in Patients Undergoing Cardiac Surgery

Melduni

Suri

Seward

et al. 2011

Journal of the American College of Cardiology

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“…1–3 AF is the most common arrhythmia after cardiac surgery and can occur in patients with or without pre-existing AF. 2 Cardiac comorbidities associated with AF include hypertension, coronary artery disease, valvular heart disease, congestive heart failure, and cardiomyopathy which are common in the cardiac surgical population.…”

Section: Introductionmentioning

confidence: 99%

The Association of Acute Kidney Injury and Atrial Fibrillation after Cardiac Surgery in an Asian Prospective Cohort Study

Tan

Liu

et al. 2016

Medicine

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Acute kidney injury (AKI) and atrial fibrillation (AF) after cardiac surgery are common occurrences and increase patient morbidity and mortality. Inflammation plays a role in increased incidence of AF in patients with chronic kidney disease (CKD); reactive oxygen species and inflammatory markers which are increased in patients with CKD were found to affect the proper functioning of the intracellular ion channels, connexions (transmembrane proteins found in intercellular gap junctions), and electrical homogeneity of the extracellular matrix which are essential for electrical stability and proper conduction of electrical impulses in the atrium. However, it is not known if similar mechanisms are also involved in AKI. We tested the hypothesis that patients with AKI after cardiac surgery have a higher incidence of postoperative AF.Data from 2885 patients, who had undergone cardiac surgery between August 2008 and July 2012 from the Singapore's 2 major heart centers, were obtained prospectively. Postoperative AKI was defined using the Acute Kidney Injury Network criteria. The primary outcome was postoperative AF, and subjects were considered to have postoperative AF if the AF lasted more than an hour, affected hemodynamics, or required medical treatment.The incidence of AKI was 29.7% and the incidence of postoperative AF was 16.8%. A total of 27.7% of AKI patients developed AF. Patients with AKI had a 2-fold increased risk of developing AF (relative risk [RR], 1.716; 95% confidence interval [CI], 1.433–2.055; P < 0.001). The following factors were found to independently increase the risk of AF in patients with AKI: age (RR, 1.011; 95% CI, 1.000–1.022; P = 0.04), low preoperative hemoglobin (RR, 0.942; 95% CI, 0.888–1.000; P = 0.05), low preoperative estimated glomerular filtration rate (eGFR) (RR, 0.987; 95% CI, 0.980–0.994; P < 0.001), and lowest hematocrit during bypass (RR, 0.943; 95% CI, 0.910–0.978; P < 0.001).Patients with AKI are more likely to develop postoperative AF. These patients were older and had lower preoperative hemoglobin, eGFR, and lower nadir hematocrit during bypass. Identification of high-risk AKI patients with early prevention and treatment of AF should reduce the long-term morbidity and mortality among Asian patients undergoing cardiac surgery.

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“…This could help explaining the observed association between preoperative AF and postoperative renal complications. There are, however, several confounding factors (76,77). Other risk factors were hypertension, peripheral arterial disease, bypass time over 70 minutes, severe angina an non-elective surgery (67,78).…”

Section: Non Cardiac Hospital Complicationsmentioning

confidence: 99%

The 30 Day Complication Rate After Aortic Valve Replacement with a Pericardial Valve in a Mainly Geriatric Population

Mistiaen¹

2012

Special Topics in Cardiac Surgery

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Postcardiac Surgery Complications: Association of Acute Renal Dysfunction and Atrial Fibrillation

Cited by 36 publications

References 28 publications

Diastolic Dysfunction in Patients Undergoing Cardiac Surgery

Diastolic Dysfunction in Patients Undergoing Cardiac Surgery

The Association of Acute Kidney Injury and Atrial Fibrillation after Cardiac Surgery in an Asian Prospective Cohort Study

The 30 Day Complication Rate After Aortic Valve Replacement with a Pericardial Valve in a Mainly Geriatric Population

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