Kievišas Mantas, Keturakis Vytenis, Vaitiekūnas Egidijus, Dambrauskas Lukas, Jankauskienė Loreta, Kinduris Šarūnas
Medical Academy, Lithuanian University of Health Sciences, Kaunas, 2 Eiveniu St, 50009, Kaunas, Lithuania.
Department of Cardiothoracic and Vascular Surgery, Medical Academy, Lithuanian University of Health Sciences, Kaunas, 2 Eiveniu St, 50009, Kaunas, Lithuania.
Gen Thorac Cardiovasc Surg. 2017 Oct;65(10):566-574. doi: 10.1007/s11748-017-0797-6. Epub 2017 Jun 24.
Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery. To prevent this complication, routine pharmacological prophylactic drugs could be administered. Our study aimed to analyze the various perioperative factors associated with the development of POAF after coronary artery bypass graft (CABG) surgery.
This prospective study included 617 patients, who received CABG surgery in the year 2014.
There were 429 (69.5%) male and 188 (30.5%) female patients. Mean patient age was 67.2 (9.4) years, and 365 patients (59.2%) were more than 65 years. Incidence of POAF was 24.1% (N = 149). Multivariable analysis showed that independent predictors of POAF after CABG surgery were: age >65 (P = 0.008; OR 2.089; 95% CI 1.208-3.613), AF in the past (P < 0.001; OR 10.838; 95% CI 5.28-22.247), preoperative hypertrophy or dilation of left atrium (P = 0.002; OR 4.996; 95% CI 1.823-13.691), CABG surgery using 4 or more bypass grafts (P = 0.042; OR 1.669; 95% CI 0.972-2.866), preoperative hypokalemia (P = 0.001; OR 3.317; 95% CI 1.678-6.559), >trivial mitral (P = 0.024; OR 7.556; 95% CI 0.964-20.376), and aortic (P = 0.009; OR 1.937; 95% CI 1.178-3.187) valve regurgitation.
The profile of patients affected by POAF was considerably different with regard to the demographics, preoperative heart condition, history of previous heart rhythm disorders, and operative data. The most important independent factors that predicted POAF after CABG surgery were associated with structural heart defects, advanced age, history of previous AF, and preoperative hypokalemia.
术后房颤（POAF）是心脏手术后最常见的并发症。为预防该并发症，可使用常规药理学预防性药物。我们的研究旨在分析冠状动脉旁路移植术（CABG）后与POAF发生相关的各种围手术期因素。
这项前瞻性研究纳入了2014年接受CABG手术的617例患者。
男性患者429例（69.5%），女性患者188例（30.5%）。患者平均年龄为67.2（9.4）岁，365例患者（59.2%）年龄超过65岁。POAF发生率为24.1%（N = 149）。多变量分析显示，CABG术后POAF的独立预测因素为：年龄>65岁（P = 0.008；OR 2.089；95%CI 1.208 - 3.613）、既往有房颤（P < 0.001；OR 10.838；95%CI 5.28 - 22.247）、术前左心房肥厚或扩张（P = 0.002；OR 4.996；95%CI 1.823 - 13.691）、使用4根或更多旁路移植物进行CABG手术（P = 0.042；OR 1.669；95%CI 0.972 - 2.866）、术前低钾血症（P = 0.001；OR 3.317；95%CI 1.678 - 6.559）、轻度二尖瓣反流（P = 0.024；OR 7.556；95%CI 0.964 - 20.376）和主动脉瓣反流（P = 0.009；OR 1.937；95%CI 1.178 - 3.187）。
在人口统计学、术前心脏状况、既往心律紊乱病史和手术数据方面，受POAF影响的患者特征有很大差异。CABG术后预测POAF的最重要独立因素与结构性心脏缺陷、高龄、既往房颤病史和术前低钾血症有关。
