Risk Factors for Intraoperative Atrial Fibrillation: A Retrospective Analysis of 10,563 Lung Operations in a Single Center

Wu, Dehua; Xu, Meiying; Mao, Teng; Cao, Hui; Wu, Dongjin; Shen, Yaqi

doi:10.1016/j.athoracsur.2012.03.057

Cited by 31 publications

(16 citation statements)

References 25 publications

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“…In an extensive retrospective analysis by Wu et al [36], which reported an overall incidence of PAF of 3.27%, it was found that age, male gender, lung cancer, general anesthesia, open surgery, lobe resection, and duration of the operation resulted in risk factors of PAF. In another retrospective study by Muranishi et al, conducted on 593 patients [37], the overall incidence of PAF was 6.4%.…”

Section: Risk Factors Triggers and Pathophysiology Of Pafmentioning

confidence: 99%

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Fabiani

Colombo

Bacchiani

et al. 2019

JCM

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Atrial fibrillation (AF) is a common supraventricular arrhythmia, a recognized risk factor for ischemic stroke, as a potential driver for heart failure (HF). Cancer patients have an increased risk for AF, even not including any cancer-specific treatment, as surgery or chemotherapy. The mechanism is multifactorial, with inflammation and changes in autonomic tone as critical actors. Commonly, AF is a recurrent complication of the post-operative period in cancer surgery (especially thoracic). Recent papers confirmed a significant incidence of post-operative (non-cardiac surgery) AF (PAF), partially mitigated by the use of prophylactic (rate o rhythm control) treatments. A relevant difference, in terms of mean hospitalization time, emerges between patients developing PAF and those who do not, while long term impact remains a matter of debate, due to several potential confounding factors. Besides clinical predictors, structural (i.e., echocardiographic) and bio-humoral findings may help in risk prediction tasks. In this respect, pre-operative natriuretic peptides (NPs) concentrations are nowadays recognized as significant independent predictors of perioperative cardiovascular complications (including PAF), while elevated post-operative levels may further enhance risk stratification. The aim of the present paper is to trace the state of the art in terms of incidence, management, prevention, and outcome of PAF in the field of thoracic surgical oncology.

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Section: Risk Factors Triggers and Pathophysiology Of Pafmentioning

confidence: 99%

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Fabiani

Colombo

Bacchiani

et al. 2019

JCM

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“…As mentioned above, postoperative AF is associated with mediastinal lymph node dissection (16,17) and L-SND may prevent postoperative AF by leaving specific mediastinal lymph node stations near the cardiac plexus or pulmonary veins untouched and unresected, as found by Okada et al Thus, considering the results of Bille et al from therapeutic and postoperative perspectives, we consider that L-SND seems to be the more favorable procedure in surgical treatment of early stage NSCLC, compared to SND.…”

Section: Editorialmentioning

confidence: 89%

“…Maniwa et al also showed that postoperative arrhythmia tended to be more common after SND than after L-SND (13). Intra-and postoperative AF are associated with mediastinal lymph node dissection and often require anticoagulant agents, cause prolongation of hospital stay and brain infarction, and may be fatal (16,17). The mechanism of onset involves surgical maneuvers during mediastinal nodal dissection and postoperative local inflammation around the vagal nerve, especially the cardiac plexus, and pulmonary veins.…”

Section: Editorialmentioning

confidence: 99%

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

2017

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The standard surgical treatment for early stage non-smallcell lung cancer (NSCLC) is lobectomy or pneumonectomy with systematic lymph node dissection (SND) (1,2). In 2006, the European Society of Thoracic Surgeons (ESTS) released guidelines for intraoperative lymph node staging in NSCLC, in which intraoperative procedures for lymph nodes were classified into five groups; selected lymph node biopsy, (systematic) sampling, lobe-specific lymph node dissection (L-SND), SND, and extended lymph node dissection; and it was recommended to provide SND in all cases of complete resection of NSCLC (3). SND was first reported by Cahan in 1960 (4). This technique is designed to provide precise information on nodal status, which is necessary for optimal postoperative treatment, and to achieve better local cancer control that subsequently improves postoperative survival. However, the influence of SND on local control and survival remains uncertain, even though its value for accurate histologic staging of nodal status is well accepted. In addition, some reports have shown that SND tends to require longer operative times and to increase perioperative complications, compared to other procedures (5-7). Thus, many surgeons tend to avoid SND and perform "less invasive" intraoperative treatment for lymph nodes (8).Based on this background, L-SND has attracted attention as a procedure in which some nodal stations are left untouched and unresected depending on the lobar location of the primary tumor. L-SND is designed based on characteristic mediastinal nodal metastasis patterns that occur for different primary tumor locations. In 1998, Okada et al. showed the characteristic skip N2 metastasis pattern (9), and in 1999, Asamura et al. reported characteristic patterns based on the primary tumor location (10). According to their report, tumors in the RUL and LUL tend to metastasize to the superior mediastinal lymph node station, whereas single-station metastasis to the subcarinal node is very rare; while tumors in the RLL or LLL show metastases to the subcarinal node and to the superior mediastinal or aortic node (10). However, Asamura et al. concluded that subcarinal node metastasis was the touchstone of mediastinal spread of RLL and LLL tumors because singlenode or single-station metastases were more common in the subcarinal station and the prognosis of RLL or LLL tumors with both subcarinal and superior mediastinal lymph node metastases was extremely poor, even if SND was performed. Further, a specific lymphatic spread pattern was not identified for RML tumors (10).Comparing L-SND with SND from nodal staging Editorial

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“…With OPCABG after lung resection, patients with CHD who will receive non-cardiac surgery are high risk of perioperative major adverse cardiac events. Patients will more likely develop peri-operative hypoxemia, [ 14 ] various types of arrhythmia, [ 15 ] even cardiac arrest, [ 16 ] which may lead to lethal myocardial infarction. Perioperative myocardial ischemia has identified as a major predictor of cardiac complications, [ 17 ] which can lead to high morbidity and mortality.…”

Section: Discussionmentioning

confidence: 99%

Anesthetic management of off-pump simultaneous coronary artery bypass grafting and lobectomy

Zhao

Kong

et al. 2017

Medicine

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Rationale:Survey data show approximately 10% patients with lung cancer may present concomitant coronary heart disease. Simultaneous surgery is a challenge for anesthetist. We review our experience in the anesthesia with 5 patients who required simultaneous off-pump coronary artery bypass grafting (OPCABG) and pulmonary resection for lung cancer.Patient concerns:Between 2014 and 2016, 5 patients with ASA (American Society of Anesthesiologists) grade II or III, underwent combined OPCABG and lung resection in the first Affiliated Hospital, Zhejiang University School of Medicine.Diagnoses:All five patients were diagnosed with coronary heart disease and peripheral pulmonary carcinomaInterventions:Five patients received general anesthesia with double-lumen endobronchial tube for lung separation. The anesthetics were used, which caused slight hemodynamic fluctuations during induction of anesthesia; while during the maintenance of anesthesia, supplemented by Dexmedetomidine, the drug doses were titrated according to the depth of anesthesia. Guided by cardiac index (CI), stroke volume variation (SVV) and oxygen delivery (DO2), different strategies were taken at the different stage of surgery, during lung resection, SVV was kept about 13% to 15%, and less than 10% during OPCABG.Outcomes:Five patients were transferred to intensive care unit (ICU) with intubation after surgery, duration of ventilation was 10 to 18 hours, and length of ICU stay and hospital stay were 1.8 to 2.5 ds and 11 to 16 ds, respectively. All of patients were discharged with not any perioperative complication.Lessons:In summary, anesthetists should focus on the maintenance of the balance between oxygen supply and demanding, which was achieved by close monitoring, titration of anesthetics and goal-directed fluid therapy during surgical procedures.

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Risk Factors for Intraoperative Atrial Fibrillation: A Retrospective Analysis of 10,563 Lung Operations in a Single Center

Cited by 31 publications

References 25 publications

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Incidence, Management, Prevention and Outcome of Post-Operative Atrial Fibrillation in Thoracic Surgical Oncology

Mediastinal lymph node dissection in surgical treatment for early stage non-small-cell lung cancer: lobe-specific or systematic?

Anesthetic management of off-pump simultaneous coronary artery bypass grafting and lobectomy

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