Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland.
Heart Center, Kuopio University Hospital, and School of Medicine, University of Eastern Finland, Kuopio, Finland.
Artif Organs. 2020 Nov;44(11):1176-1183. doi: 10.1111/aor.13756. Epub 2020 Jul 20.
Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery with an incidence between 15% and 50% and pathophysiology not fully known. By choosing the method of extracorporeal circulation with focus on the reduction of systemic inflammatory response, one can potentially decrease the risk of POAF. In this prospective, randomized trial, we compared minimal invasive extracorporeal circulation (MiECC) with conventional extracorporeal circulation (CECC) in the prevention of POAF after coronary artery bypass surgery (CABG). A total of 240 patients who were scheduled for their first on-pump CABG, were randomized to MiECC or CECC. The primary outcome measure was the incidence of first POAF during the first 84 hours after surgery. POAF occurred in 42/120 (35.0%) MiECC patients and 43/120 (35.8%) CECC patients with nonsignificant difference between the groups (OR 1.043, 95% CI 0.591-1.843, P = .884). The first postoperative creatine kinase-MB mass (CK-MBm) value was lower in the MiECC group, 13.95 [10.5-16.7] (median [IQR]) than in the CECC group, 15.30 [11.4-18.9] (P = .036), whereas the use of perioperative dobutamine was higher in the MiECC group, 18/120 (15.0%), than in the CECC group 8/120 (6.7%) (P = .038). The incidence of a stroke, perioperative myocardial infarction, and resternotomy caused by bleeding did not differ in the MiECC and CECC groups. Age (OR 1.08, 95% CI 1.04-1.13, P = .000) and peak postoperative CK-MBm (OR 1.57, 95% CI 1.06-2.37, P = .026) were independent predictors of POAF. MiECC compared to CECC was not effective in reducing the incidence of POAF in patients undergoing CABG.
术后心房颤动（POAF）是心脏手术后最常见的心律失常，发生率在 15%至 50%之间，其病理生理学尚未完全明确。通过选择体外循环方法，重点减少全身炎症反应，有可能降低 POAF 的风险。在这项前瞻性、随机试验中，我们比较了微创体外循环（MiECC）与传统体外循环（CECC）在预防冠状动脉旁路移植术（CABG）后 POAF 中的作用。共有 240 名计划进行第一次体外循环 CABG 的患者被随机分为 MiECC 或 CECC 组。主要观察指标是术后 84 小时内首次 POAF 的发生率。MiECC 组 42/120（35.0%）和 CECC 组 43/120（35.8%）患者发生 POAF，两组间无显著差异（OR 1.043，95%CI 0.591-1.843，P=0.884）。MiECC 组术后肌酸激酶同工酶-MB 质量（CK-MBm）值较低，13.95[10.5-16.7]（中位数[IQR]），而 CECC 组为 15.30[11.4-18.9]（P=0.036），而 MiECC 组围手术期使用多巴酚丁胺的比例较高，18/120（15.0%），而 CECC 组 8/120（6.7%）（P=0.038）。MiECC 组和 CECC 组的卒中、围手术期心肌梗死和因出血导致的再次开胸发生率无差异。年龄（OR 1.08，95%CI 1.04-1.13，P=0.000）和术后峰值 CK-MBm（OR 1.57，95%CI 1.06-2.37，P=0.026）是 POAF 的独立预测因素。与 CECC 相比，MiECC 不能有效降低 CABG 患者 POAF 的发生率。
