Kalp Cerrahisi Yapılan Hastalarda Erken Dönemde Gelişen Postperikardiyotomi Sendromu ve Atriyal Fibrilasyon Arasındaki İlişki

Yıl 2016, Cilt: 19 Sayı: 2, 85 - 90, 01.08.2016

Utkan Sevük Fırat Ayaz Kaan Köse Ertan Demirdaş Aylin Erkul

Öz

Giriş:
Postoperatif atriyal fibrilasyon (POAF) ve
postperikardiyotomi sendromu (PPS) kalp cerrahisinin sık görülen komplikasyonları
arasında yer alır. POAF ve PPS uzamış yatış süreleri, yüksek morbidite ve
mortalite oranları ve yüksek sağlık bakım maliyetleri ile ilişkili bulunmuştur.
Her iki komplikasyonun da patogenezinde inflamasyon suçlanmakla birlikte, PPS
ve POAF arasındaki ilişki açıklığa kavuşmamıştır. Bu çalışmanın amacı koroner
baypas yapılan hastalarda, erken dönemde gelişen PPS ve POAF arasındaki
ilişkiyi incelemektir.

Hastalar
ve Yöntem: Kliniğimizde kardiyopulmoner
baypas altında koroner baypas operasyonu yapılmış olan hastaların kayıtları
retrospektif olarak incelendi. Takibinde POAF gelişmiş olan ardışık 60 hasta
çalışmaya dahil edildi. Takiplerinde POAF gelişmeyen koroner baypas cerrahisi
yapılmış ardışık 142 hasta kontrol grubuna dahil edildi.

Bulgular:
POAF gelişen hastalarda, POAF gelişmeyen hastalarla
karşılaştırıldığında erken PPS gelişme sıklığı anlamlı olarak daha yüksek
bulunmuştur (%61.7 vs %45.8, p= 0.04 ). Lojistik regresyon analizinde, POAF
gelişen hastalarda erken PPS gelişme riskinin daha fazla olduğu saptandı (Odds
oranı  1.9, %95 güven aralığı 1.03-3.5,
p= 0.04).

Sonuç: Çalışmamızda, izole koroner baypas
ameliyatı yapılmış ve POAF gelişen hastalarda, erken PPS gelişim riskinin POAF
gelişmeyen hastalarla karşılaştırıldığında daha fazla olduğu saptandı. POAF
gelişen hastalar, erken PPS gelişimi açısından yakından takip edilmelidir.

Anahtar Kelimeler

Postperikardiyotomi sendromu, postoperatif atriyal fibrilasyon, koroner baypas

Relationship Between Early Post-Pericardiotomy Syndrome and Atrial Fibrillation After Cardiac Surgery

Öz

Introduction:
Post-operative atrial fibrillation (POAF) and
post-pericardiotomy syndrome (PPS) are common complications of cardiac surgery.
Both PPS and POAF are associated with increased morbidity, mortality, costs and
length of stay after cardiac surgery. Inflammation is involved in the
pathogenesis of both PPS and POAF; however, the relationship between PPS and
POAF remains unclear. The aim of this study was to examine the relationship
between early PPS and POAF in patients who underwent cardiac surgery.

Patients
and Methods: Records of patients who underwent on-pump
coronary artery bypass graft (CABG) surgery were retrospectively reviewed. A
total of 60 consecutive patients who were diagnosed with POAF were included in
the study, while 142 consecutive patients who were not diagnosed with POAF were
included as controls.

Results:
An early PPS development was significantly higher
in patients with POAF than in patients without POAF (61.7% vs 45.8%, p= 0.04).
Logistic regression analysis demonstrated that patients with POAF had 1.9-times
increased risk for developing early PPS (OR, 1.9; 95% CI, 1.03-3.5; p= 0.04).

Conclusion: This study showed that POAF was
associated with an increased incidence of early PPS in patients who underwent
isolated CABG surgery. Therefore, patients with POAF should be closely
monitored for the occurrence of early PPS.

Anahtar Kelimeler

Post-pericardiotomy syndrome, post-operative atrial fibrillation, coronary artery bypass graft surgery

Kaynakça

• 1. Asher CR, Miller DP, Grimm RA, Cosgrove DM, Chung MK. Analysis of risk factors for development of atrial fibrillation early after cardiac valvular surgery. Am J Cardiol 1998;82:892-5.
• 2. Echahidi N, Pibarot P, O’Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 2008;51:793-801.
• 3. Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: a model for preoperative risk stratification. Circulation 2000;101:1403-8.
• 4. Yanartaş M, Demir H, Hançer H, Erdem H, Çakalağaoğlu KC, Çevirme D ve ark. Koroner baypas cerrahisi sonrasında atriyal fibrilasyon gelişen hastalarda risk faktörlerinin değerlendirilmesi. Kosuyolu Heart J 2015;18:76-9.
• 5. Bostan C, Abacı O, Koçaş C, Coşkun U, Yıldız A, Sarı M ve ark. Long-term mortality of nonvalvular atrial fibrillation. Kosuyolu Heart J 2015;18:135-8.
• 6. Prince SE, Cunha BA. Postpericardiotomy syndrome. Heart Lung 1997;26:165-8.
• 7. Finkelstein Y, Shemesh J, Mahlab K, Abramov D, Bar-El Y, Sagie A, et al. Colchicine for the prevention of post-pericardiotomy syndrome. Herz 2002;27:791-4.
• 8. Tsang TS, Barnes ME, Hayes SN, Freeman WK, Dearani JA, Butler SL, et al. Clinical and echocardiographic characteristics of significant pericardial effusions following cardiothoracic surgery and outcomes of echo­guided pericardiocentesis for management. Mayo Clinic experience, 1979-­1998. Chest 1999;116:322-31.
• 9. Imazio M, Brucato A, Ferrazzi P, Pullara A, Adler Y, Barosi A, et al; COPPS-2 Investigators. Colchicine for prevention of postpericardiotomy syndrome and postoperative atrial fibrillation: the COPPS-2 randomized clinical trial. JAMA 2014;312:1016-23.
• 10. Erlich JF, Paz Z. Postpericardial injury syndrome: An autoimmune phenomenon. Clin Rev Allergy Immunol 2010;38:156-8.
• 11. Kim S, Sahn SA. Postcardiac injury syndrome. An immunologic pleural fluid analysis. Chest 1996;109:570-2.
• 12. Mason TG, Neal WA, DiBartolomeo AG. Elevated antinuclear antibody titers and the PPS. J Pediatr 1990;116:403-4.
• 13. Snefjellå N, Lappegård KT. Development of post-pericardiotomy syndrome is preceded by an increase in pro-inflammatory and a decrease in anti-inflammatory serological markers. J Cardiothorac Surg 2012;7:72.
• 14. Jaworska-Wilczyńska M, Magalska A, Piwocka K, Szymański P, Kuśmierczyk M, Wąsik M, et al. Low interleukin - 8 level predicts the occurrence of the postpericardiotomy syndrome. PLoS One 2014; 9:e108822.
• 15. Bessissow A, Khan J, Devereaux PJ, Alvarez-Garcia J, Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: an overview. J Thromb Haemost 2015;13(Suppl 1):S304-S312.
• 16. Aviles RJ, Martin DO, Apperson-Hansen C, Houghtaling PL, Rautaharju P, Kronmal RA, et al. Inflammation as a risk factor for atrial fibrillation. Circulation 2003;108:3006-10.
• 17. Maganti M, Badiwala M, Sheikh A, Scully H, Feindel C, David TE, et al. Predictors of low cardiac output syndrome after isolated mitral valve surgery. J Thorac Cardiovasc Surg 2010;140:790-6.
• 18. Imazio M, Hoit BD. Post-cardiac injury syndromes. An emerging cause of pericardial diseases. Int J Cardiol 2013;168:648-52.
• 19. Paparella D, Yau TM, Young E. Cardiopulmonary bypass induced inflammation: pathophysiology and treatment. An update. Eur J Cardiothorac Surg 2002;21:232-44.
• 20. Abdelhadi RH, Gurm HS, Van Wagoner DR, Chung MK. Relation of an exaggerated rise in white blood cells after coronary bypass or cardiac valve surgery to development of atrial fibrillation postoperatively. Am J Cardiol 2004;93:1176-8.
• 21. Ishii Y, Schuessler RB, Gaynor SL, Yamada K, Fu AS, Boineau JP, et al. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation 2005;111:2881-8.
• 22. Van Wagoner DR. Colchicine for the prevention of postoperative atrial fibrillation: a new indication for a very old drug? Circulation 2011;124:2281-2.
• 23. Watanabe T, Takeishi Y, Hirono O, Itoh M, Matsui M, Nakamura K, et al. C-reactive protein elevation predicts the occurrence of atrial structural remodeling in patients with paroxysmal atrial fibrillation. Heart Vessels 2005;20:45-9.
• 24. Psychari SN, Apostolou TS, Sinos L, Hamodraka E, Liakos G, Kremastinos DT. Relation of elevated C-reactive protein and interleukin-6 levels to left atrial size and duration of episodes in patients with atrial fibrillation. Am J Cardiol 2005;95:764-7.
• 25. Desborough JP. The stress response to trauma and surgery. Br J Anaesth 2000;85:109-17.
• 26. Marik PE, Flemmer M. The immune response to surgery and trauma: implications for treatment. J Trauma Acute Care Surg 2012;73:801-8
• 27. Landis RC. Redefining the systemic inflammatory response. Semin Cardiothorac Vasc Anesth 2009;13:87-94.
• 28. Bruins P, te Velthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, et al. Activation of the complement system during and after cardiopulmonary bypass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 1997 ;96: 3542-3548.
• 29. Boos CJ, Anderson RA, Lip GYH. Is atrial fibrillation an inflammatory disorder? European Heart Journal 2006;27:136-49.
• 30. Maesen B, Nijs J, Maessen JN, Allessie M, Schotten U. Post-operative atrial fibrillation: A maze of mechanisms. Europace 2012;14:159-74.
• 31. Jacob KA, Nathoe HM, Dieleman JM, van Osch D, Kluin J, van Dijk D. Inflammation in new-onset atrial fibrillation after cardiac surgery: A systematic review. Eur J Clin Invest 2014;44:402-28.
• 32. Chen MC, Chang JP, Liu WH, Yang CH, Chen YL, Tsai TH, et al. Increased inflammatory cell infiltration in the atrial myocardium of patients with atrial fibrillation. Am J Cardiol 2008;102:861-5.
• 33. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015;154:13-20.
• 34. Rudolph V, Andrié RP, Rudolph TK, Friedrichs K, Klinke A, Hirsch-Hoffmann B, et al. Myeloperoxidase acts as a profibrotic mediator of atrial fibrillation. Nat Med 2010;16:470-4.