Koroner Baypas Cerrahisi Sonrasında Atriyal Fibrilasyon Gelişen Hastalarda Risk Faktörlerinin Değerlendirilmesi

Abstract

Giriş: Postoperatif atriyal fibrilasyon (AF) kardiyak operasyonlar sonrasında mortalite ve morbiditeye etki eden önemli bir faktördür. Bu çalışmada, kliniğimizde yapılan koroner baypas operasyonları sonrası AF gelişme sıklığının ve risk faktörlerinin araştırılması amaçlanmıştır.

Hastalar ve Yöntem: Kliniğimizde Ocak 2011- Nisan 2011 yılları arasında yapılan koroner baypas operasyonlarının kayıtları retrospektif olarak incelenmiştir. Çalışmaya 211 hasta dahil edilmiştir. Postoperatif AF gelişen hastalar Grup I, gelişmeyen hastalar ise Grup II olarak sınıflandırılmıştır. İki grup, diabetes mellitus (DM), hipertansiyon (HT), sigara kullanımı, kronik obstrüktif akciğer hastalığı (KOAH), distal anastomoz sayısı ve aort kros klemp süresi (AKK) açısından karşılaştırılmıştır.

Bulgular: Grup I’deki hastaların 33 (%68)’ü erkek, 15 (%32)’i kadın hasta, Grup II’deki hastaların 119 (%73)’u  erkek, 44 (%27)’ü kadındı. Ortalama yaş Grup I’de 66.2 ± 10.8 yıl, Grup II’de 60.4 ± 9.3 yıl olarak saptandı (p< 0.05). Gruplar arasında DM, sigara alışkanlığı, HT ve KOAH açısından anlamlı fark yoktu. Distal anastomoz sayısı Grup I’de ortalama 5.6 ± 2.1, Grup II’de ise ortalama 3.5 ± 2.4 idi (p< 0.05). AKK süresi I. Grupta ortalama 58.2 ± 29.1 dakika, II. Grupta ortalama 39.6 ± 18.4 dakika olarak bulundu (p< 0.05). Ortalama yatış süresi Grup I’de 5.2 ± 2.6 gün, Grup II’de 4.5 ± 3.1 gün olarak belirlendi. Erken dönem mortalite izlenmedi (Taburculuk sonrası ilk bir ay). Yaş, AKK ve distal anastomoz sayısı, postoperatif AF gelişimini etkileyen temel faktörler olarak belirlendi.

Sonuç: Postoperatif AF operasyonel faktörlerden etkilenebilmektedir. Değiştirilebilen risk faktörlerinin kontrolü postoperatif AF gelişimini önleyebilir.

Keywords

• Atriyal fibrilasyon,koroner baypas cerrahisi,risk faktörleri

Evaluation of Risk Factors for Atrial Fibrillation Occurring After Coronary Bypass Surgery

Abstract

Introduction: Postoperative atrial fibrillation (AF) is an important determinant of mortality and morbidity after cardiac surgery. In this study, our aim was to examine the incidence of and risk factors for AF developing after coronary bypass surgery.

Patients and Methods: Patients undergoing coronary bypass surgery between January 2011 and April 2011 in our department were examined retrospectively. A total of 211 patients were included in the study. Patients with postoperative AF comprised Group I, while those without comprised Group II. The two groups were compared in terms of a number of potential risk factors for AF including the presence of diabetes mellitus (DM), hypertension (HT), cigarette smoking, chronic obstructive pulmonary disease (COPD), number of distal anastomoses, and aortic cross clamp time (ACC).

Results: There were 33 (68%) were male and 15 (32%) female patients in Group I and 119 (73%) male and 44 (27%) female patients in Group II, respectively. Mean age was 66.2 ± 10.8 years in Group I and 60.4 ± 9.3 years in Group II (p= 0.001). There were no significant differences between study groups in terms of the incidence of DM, smoking, HT or COPD. Number of distal anastomoses were 5.6 ± 2.1 in Group I and 3.5 ± 2.4 in Group II (p< 0.05). ACC time was 48.2 ± 29.1 and 59.6 ± 18.4 minutes in Groups I and II, respectively (p< 0.05). Mean duration of hospitalization was 5.2 ± 2.6 days in Group I and 4.5 ± 3.1 days in Group II. No early mortality occurred during the first month after discharge. Age, ACC, and number distal anastomoses emerged as determinants of the risk of postoperative AF.

Conclusion: The risk of postoperative AF is dependent on certain surgical factors. Control of modifiable risk factors can assist in the prevention of postoperative AF.

Keywords

• Atrial fibrillation,coronary bypass surgery,risk factors

References

1. 1. Omae T, Kanmura Y. Management of postoperative atriyal fibrillation. J Anesth 2012;26:429-37.
2. 2. Frendl G, Sodickson AC, Chung MK, Waldo AL, Gersh BJ, Tisdale JE, et al. American Association for Thoracic Surgery. 2014 AATS guidelines for the prevention and management of perioperative atrial fibrillation and flutter for thoracic surgical procedures. J Thorac Cardiovasc Surg 2014;148:e153-93.
3. 3. Ommen SR, Odell JA, Stanton MS. Atrial arrytmias after cardiothoracic surgery. N Engl J Med 1997;336:1429-37.
4. 4. Cox JL. A perspective of postopertive atrial fibrillation in cardiac operations. Ann Thorac Surg 1993;56:405-9.
5. 5. Maesen B, Nijs J, Maessen J, Allessie M, Schotten U. Post-operative atrial fibrillation: a maze of mechanisms. Europace 2012;14:159-74.
6. 6. Algahtani AA. Atrial fibrillation post cardiac surgery trends toward management. Heart Views 2010;11:57-63. doi: 10.4103/1995-705X.73212.
7. 7. Raja SG, Dreyfus GD. Incidence of atrial fibrillation after off-pump and on-pump coronary artery surgery: current best available evidence. Internet J. Thorac. Cardiovasc Surg 2004;2:6.
8. 8. The Criteria Committee of the New York Heart Association. Nomenclature and Criteria for Diagnosis of Diseases of the Heart and Great Vessels. 9th ed. Boston, Mass: Little, Brown & Co 1994:253-6.

9. 9. Turagam MK, Downey FX, Kress DC, Sra J, Tajik AJ, Jahangir A. Pharmacological strategies for prevention of postoperative atrial fibrillation. Expert Rev Clin Pharmacol 2015;8:233-50.
10. 10. Bruins P, Velthuis H, Yazdanbakhsh AP, Jansen PG, van Hardevelt FW, de Beaumont EM, et al. Activation of the complement system during and after cardiopulmonary by pass surgery: postsurgery activation involves C-reactive protein and is associated with postoperative arrhythmia. Circulation 1997;96:3542-8.
11. 11. Wijffels MC, Kirchof CJ, Dorland R, Allessie MA. Atrial fibrillation begets atrial fibrillation. Circulation 1995;92:1954-68.
12. 12. Krogstad LE, Slagsvold KH, Wahba A. Remote ischemic preconditioning and incidence of postoperative atrial fibrillation. Scand Cardiovasc J 2015; 24:1-6.
13. 13. Kadan M, Erol G, Oz BS, Arslan M. Effects of topical hypothermia on postoperative inflammatory markers in patients undergoing coronary artery bypass surgery. Cardiovasc J Afr 2014;25:67-72.
14. 14. Rostagno C, Blanzola C, Pinelli F, Rossi A, Carone E, Stefàno PL. Atrial fibrillation after isolated coronary surgery. Incidence, long term effects and relation with operative technique. Heart Lung Vessel 2014;6:171-9.
15. 15. Matsuura K, Mogi K, Sakurai M, Kawamura PJ, Misue T, Hatakeyama I, et al. Preoperative high N-terminal pro-B-type natriuretic peptide level can predict the incidence of postoperative atrial fibrillation following off-pump coronary artery bypass grafting. Ann Thorac Cardiovasc Surg 2013;19:375-81.
16. 16. Leitch JW, Thomson D, Baird KD, Haris PJ. The importance of age as a predictor of atrial fibrillation and flutter after coronary artery bypass grafting. J Thorac Cardiovasc Surg 1990;100:338-42.
17. 17. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial fibrillation. Ann Thorac Surg 1993;56:539-49.
18. 18. Baeza VR, Garayar PB, Moran VS, Zalaquett SR, Irarrázaval Ll MJ, Becker RP, et al. Risk factors for postoperative atrial fibrillation after coronary artery bypass grafting. A prospective analysis. Rev Med Chil 2007;135:967-74.
19. 19. Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996;94:390-7.
20. 20. Hohnloser SH. Can we predict atrial fibrillation after coronary surgery and why should we? Eur Heart J 1998;19:684-5.
21. 21. Kalman JM, Munavar M, Howes LG, Louis WJ, Buxton BF, Gutteridge G, et al. Atrial fibrillation after coronary artery by pass grafting associated with sympathetic activation. Ann Thorac Surg 1995;60:1709-15.
22. 22. Incalzi RA, Pistelli R, Fuso L, Cocchi A, Bonetti MG, Giordano A. Cardiac arrhythmias and left ventricular function in respiratory failure from chronic obstructive pulmonary disease. Chest 1990;97:1092-7.