Comparison of Normothermic and Hypothermic Cardiopulmonary Bypass in the Development of Postoperative Atrial Fibrillation

Öz

Aim: Postoperative atrial fibrillation (PoAF) is common after cardiac surgery and has been linked to adverse outcomes. Temperature management during Cardiopulmonary bypass (CPB), particularly normothermia versus hypothermia, remains controversial due to its potential impact on PoAF. This study aimed to compare the effects of normothermic (35-37°C) and hypothermic (28-32°C) CPB on PoAF incidence in patients undergoing cardiac surgery. Methods: We retrospectively analyzed 50 consecutive adults undergoing CABG, valve surgery, or septal defect repair with CPB. Patients were managed with either normothermic or hypothermic CPB. Continuous ECG monitoring was performed for the first 48 h postoperatively, and PoAF was defined by absent P waves with irregular ventricular rhythm, verified by specialists. Group comparisons used standard statistical tests, with p<0.05 considered statistically significant. Results: Overall PoAF incidence was 36%. PoAF did not differ significantly between hypothermic and normothermic CPB (p=0.267). Patients with PoAF had numerically higher mean intraoperative temperatures (34.63 °C vs. 33.38 °C; p=0.083) and longer CPB duration (114.33 vs. 98.30 min; p=0.090), although neither reached statistical significance. PoAF proportions were 41.66% after valve surgery, 35.71% after CABG, and 30.0% after septal defect repair (p=0.922). Conclusion: In this retrospective study, the incidence of PoAF did not differ significantly between hypothermic and normothermic CPB. Although higher intraoperative temperature and prolonged CPB duration showed a tendency toward increased PoAF, these trends were not statistically significant. The findings indicate that temperature management strategy alone is unlikely to be a decisive factor, and further prospective studies are required to clarify its role in PoAF prevention.

Anahtar Kelimeler

• Postoperative atrial fibrillation
• Cardiopulmonary bypass
• Normothermia
• Hypothermia
• Cardiovascular surgery

Destekleyen Kurum

None

Proje Numarası

Proje No Yok

Etik Beyan

Ethics approval was obtained from the Harran University Medical Faculty Ethics Committee (Document Date and Number: 10.01.2023-196558, Approval Number: HRÜ: 22.25.18). The requirement for individual informed consent was waived because of the retrospective study design.

Teşekkür

We would like to thank Harran University Faculty of Medicine Cardiovascular Surgery Clinic for their support.

Postoperatif Atriyal Fibrilasyon Gelişiminde Normotermik ve Hipotermik Kardiyopulmoner Bypassın Karşılaştırılması

Öz

Amaç: Postoperatif atriyal fibrilasyon (PoAF), kardiyak cerrahi sonrası sık görülen ve olumsuz sonuçlarla ilişkilendirilen bir komplikasyondur. Kardiyopulmoner bypass (KPB) sırasında sıcaklık yönetimi, özellikle normotermi ile hipotermi arasındaki farklılıklar, PoAF üzerindeki potansiyel etkileri nedeniyle tartışmalıdır. Bu çalışmanın amacı, kardiyak cerrahi geçiren hastalarda normotermik (35–37 °C) ve hipotermik (28–32 °C) KPB’nin PoAF insidansı üzerindeki etkilerini karşılaştırmaktır. Gereç ve Yöntemler: KPB eşliğinde koroner arter baypas greftleme (KABG), kapak cerrahisi veya septal defekt onarımı yapılan ardışık 50 yetişkin hasta retrospektif olarak incelendi. Hastalar normotermik veya hipotermik KPB ile yönetildi. Postoperatif ilk 48 saat boyunca sürekli EKG monitorizasyonu uygulandı ve PoAF, P dalgalarının kaybolması ile düzensiz ventrikül ritmi bulguları esas alınarak uzmanlar tarafından doğrulandı. Gruplar standart istatistiksel testlerle karşılaştırıldı ve p<0,05 istatistiksel olarak anlamlı kabul edildi. Bulgular: Genel PoAF insidansı %36 olarak bulundu. PoAF sıklığı, hipotermik ve normotermik KPB arasında anlamlı farklılık göstermedi (p=0,267). PoAF gelişen hastalarda ortalama intraoperatif sıcaklık (34,63 °C’ye karşı 33,38 °C; p=0,083) ve KPB süresi (114,33 dakikaya karşı 98,30 dakika; p=0,090) daha yüksek olmasına rağmen bu farklar istatistiksel olarak anlamlı değildi. PoAF oranları kapak cerrahisi sonrası %41,66, KABG sonrası %35,71 ve septal defekt onarımı sonrası %30,0 olarak belirlendi (p=0,922). Sonuç: Bu retrospektif çalışmada, PoAF insidansı normotermik ve hipotermik KPB arasında anlamlı farklılık göstermemiştir. Daha yüksek intraoperatif sıcaklık ve uzamış KPB süresinin PoAF gelişimi açısından artış eğilimi göstermesine rağmen bu bulgular istatistiksel anlamlılık düzeyine ulaşmamıştır. Sonuçlar, yalnızca sıcaklık yönetim stratejisinin belirleyici bir faktör olmadığını ve PoAF’un önlenmesindeki rolünü netleştirmek için ileriye dönük çalışmalara ihtiyaç duyulduğunu göstermektedir.

Anahtar Kelimeler

• Postoperatif atriyal fibrilasyon
• Kardiyopulmoner bypass
• Normotermi
• Hipotermi
• Kardiyovasküler cerrahi

Destekleyen Kurum

Yok

Proje Numarası

Proje No Yok

Etik Beyan

Harran Üniversitesi Tıp Fakültesi Etik Kurulu'ndan etik onay alınmıştır (Belge Tarihi ve Numarası: 10.01.2023-196558, Onay Numarası: HRÜ: 22.25.18). Geriye dönük çalışma tasarımı nedeniyle bireysel bilgilendirilmiş onam gerekliliği kaldırılmıştır.

Teşekkür

Harran Üniversitesi Tıp Fakültesi Kalp Damar Cerrahisi Kliniğine desteklerinden dolayı teşekkür ederiz.

Kaynakça

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