Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery

Ascione, Raimondo; Caputo, Massimo; Calori, Giliola; Lloyd, Clinton; Underwood, Malcom J.; Angelini, Gianni D

doi:10.1161/01.cir.102.13.1530

Cited by 251 publications

(169 citation statements)

References 32 publications

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“…10,15 Moreover, the consistency of association between HSP65 antibodies and postoperative AF in both the overall and subgroup analyses validates our conclusion regardless of the operative technique used.…”

Section: Mandal Et Al Hsp60 Antibodies and Atrial Fibrillation 2589supporting

confidence: 82%

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Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation

et al. 2004

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Background-Atrial fibrillation (AF) is a frequently encountered arrhythmia after cardiac surgery, but its underlying mechanisms are still unclear. We hypothesize that autoimmune and inflammatory responses against heat shock protein 65 (HSP65) may be involved and hence examined the relationship between HSP65 autoantibodies and occurrence of postoperative AF. Methods and Results-A prospective study of 329 patients undergoing elective primary CABG was undertaken.Cardiovascular risk factors, ECG characteristics, medications, and intraoperative and postoperative features were documented. Anti-HSP65 antibodies and C-reactive protein levels were measured in all preoperative blood samples with ELISA. Postoperative AF was defined as the characteristic arrhythmia, lasting for at least 15 minutes and confirmed on 12-lead ECG and occurring within the first postoperative week. This occurred in 62 patients (19%). In univariate analysis, HSP65 antibodies were significantly higher in patients with postoperative AF (Pϭ0.02). History of previous myocardial infarction, duration of bypass, number of distal anastomosis, and duration of ventilation were also associated with AF (PϽ0.05), but C-reactive protein levels were not (Pϭ0.

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Section: Mandal Et Al Hsp60 Antibodies and Atrial Fibrillation 2589supporting

confidence: 82%

“…In addition, we included variables that have been associated with postoperative AF in previous studies. 1,10,11 The goodness of fit for the multivariate models was tested by Pearson's 2 and likelihood ratio tests.…”

Section: Discussionmentioning

confidence: 99%

Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation

et al. 2004

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“…It has been hypothesized that intraoperative ischemia related to hemodynamic changes during CBP plays a role in the development of POAF; it was suggested that the decreased risk of ischemic damage in beating-heart CABG surgery reduced its incidence. Initial favorable results 27, 28 were not confirmed by other authors who failed to find a relation between the techniques of CABG surgery. 29,30 Independent predictors of POAF included advanced age, female sex, a history of AF or of congestive heart failure, and the incidence of POAF.…”

Section: Atrial Fibrillation and Cardiac Surgery Discussionmentioning

confidence: 88%

Atrial Fibrillation After Cardiac Surgery: Incidence, Risk Factors, and Economic Burden

Rostagno

Meir

Gelsomino

et al. 2010

Journal of Cardiothoracic and Vascular Anesthesia

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Objective: To evaluate the incidence of postoperative atrial fibrillation (POAF), the predisposing factors, the results of treatment before discharge, and the impact on duration and costs of hospitalization.Design: A prospective observational study. Conclusions: The overall incidence of POAF in the authors' center is close to 30%; 95.3% of patients were discharged in sinus rhythm. The increase in length and costs of hospitalization (on average, 1.0 day with a burden of about €1,800/ patient) were significantly lower than in previous investigations. Methods

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“…8 -14 The largest randomized studies published to date are conflicting, with some demonstrating decreased length of hospitalization and myocardial enzyme release, 15 whereas others demonstrate decreased incidence of atrial fibrillation, length of hospitalization, and blood-product utilization with CABG surgery performed on the beating heart. 16,17 The most recent trial demonstrated decreased blood-product requirement, myocardial enzyme release, and length of hospitalization in beating-heart surgery patients. 18 Of the 3 published trials, 2 are single-surgeon experiences, and as such, the potential for bias in end points that are discretionary treatments (decision to extubate, discharge, and transfuse) is an important consideration.…”

Section: See P 810mentioning

confidence: 99%

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

et al. 2004

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Background-There is increasing evidence that cardiopulmonary bypass (CPB) may be responsible for the morbidity associated with coronary artery bypass grafting (CABG) surgery. Recent developments in cardiac stabilization devices have made CABG without CPB feasible. However, there is conflicting evidence to date from published trials comparing outcomes between CABG performed with and without CPB, with some trials indicating an advantage to the avoidance of CPB and others showing little benefit. Methods and Results-In a single-center randomized trial, 300 patients requiring CABG surgery at a single institution were prospectively randomized to have the procedure performed with CPB (nϭ150) or on the beating heart (nϭ150). Exclusion criteria for the trial included emergency procedure, concomitant major cardiac procedures, ejection fraction Ͻ30%, and reoperation. In-hospital outcomes were analyzed on an intention-to-treat basis. A mean of 3.0Ϯ0.9 grafts were performed in the CPB group compared with 2.8Ϯ0.9 grafts in the beating-heart group (Pϭ0.06). There were no significant differences between the CPB group and the beating-heart group in mortality (0.7% versus 1.3%; Pϭ1.0), transfusion (8.7% versus 9.3%), perioperative myocardial infarction (0.7% versus 2.7%; Pϭ0.37), permanent stroke (0% versus 1.3%; Pϭ0.50), new atrial fibrillation (32% versus 25%; Pϭ0.20), and deep sternal wound infection (0.7% versus 0%; Pϭ1.0). The mean time to extubation was 4 hours, the mean stay in the intensive care unit was 22 hours, and the median length of hospitalization was 5 days in both groups (PϭNS). Conclusions-In

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Predictors of Atrial Fibrillation After Conventional and Beating Heart Coronary Surgery

Abstract: CPB inclusive of cardioplegic arrest is the main independent predictor of postoperative AF in patients undergoing coronary revascularization.

Cited by 251 publications

References 32 publications

Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation

Association of Anti–Heat Shock Protein 65 Antibodies With Development of Postoperative Atrial Fibrillation

Atrial Fibrillation After Cardiac Surgery: Incidence, Risk Factors, and Economic Burden

Coronary Bypass Surgery Performed off Pump Does Not Result in Lower In-Hospital Morbidity Than Coronary Artery Bypass Grafting Performed on Pump

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