微创直接冠状动脉旁路手术后心房颤动：单中心、5 年随访研究。

Postoperative Atrial Fibrillation after Minimally Invasive Direct Coronary Artery Bypass: A Single-Center, 5-Year Follow-Up Study.

机构信息

Department of Cardiac Surgery, Peking University People's Hospital, Beijing, China.

出版信息

Heart Surg Forum. 2021 May 24;24(3):E456-E460. doi: 10.1532/hsf.3621.

DOI:10.1532/hsf.3621

PMID:34173763

Abstract

OBJECTIVE

To evaluate the risk factors and explore the mid-term outcomes of postoperative atrial fibrillation (POAF) after minimally invasive direct coronary artery bypass (MIDCAB).

METHODS

A total of 165 patients, who underwent isolated MIDCAB from 2012 to 2015, were enrolled in the study and retrospectively reviewed. Patients with preoperative arrhythmia, concomitant surgical procedures were excluded. All patients were continuously monitored for POAF until discharge, and two groups were formed: the non-POAF group (140 patients, 71.4% men, mean age 58.83±10.3 years) and the POAF group (25 patients, 84.0% men, mean age 64.52±9.0 years). Early and mid-term outcomes were evaluated, perioperative factors associated with POAF were analyzed with a binary logistic regression model, and the relationship between POAF and major adverse cardiac event (MACE) was analyzed with Cox regression model.

RESULTS

The incidence of POAF in this study was 15.15%. Patients in the POAF group had a significant higher risk of re-entry to ICU (2 cases: 2 cases=8.0%: 1.4%, P = 0.049), renal failure (2 cases: 1 case=8.0%: 0.7%, P = 0.018), and death (1 case: 0 case=4.0%: 0%, P = 0.018). Binary logistic regression showed gender (male), age were independent risk factors of POAF (P = 0.038, 95% confidence interval 1.082-16.286; P = 0.011, 95% confidence interval 1.015-1.117, respectively), preoperative ACEI or ARB usage was a protective factor of POAF (P = 0.010, 95% confidence interval 0.113-0.748). With a 5-year follow up, the overall MACE rate showed no statistical difference between the two groups (P = 0.067).

CONCLUSIONS

POAF after MIDCAB was related to postoperative morbidities, such as re-entry to ICU, renal failure, and death. Gender (male) and age were independent risk factors, while preoperative ACEI or ARB usage was a protective factor. POAF has not associated the occurrence of MACE with a mid-term follow-up.

摘要

目的

评估微创直接冠状动脉旁路移植术（MIDCAB）后心房颤动（POAF）的危险因素，并探讨其中期结果。

方法

共纳入 165 例 2012 年至 2015 年期间行单纯 MIDCAB 的患者，对其进行回顾性研究。排除术前存在心律失常、合并其他手术的患者。所有患者在术后持续监测 POAF，直至出院，并分为非 POAF 组（140 例，71.4%为男性，平均年龄 58.83±10.3 岁）和 POAF 组（25 例，84.0%为男性，平均年龄 64.52±9.0 岁）。评估早期和中期结果，采用二项逻辑回归模型分析与 POAF 相关的围手术期因素，并采用 Cox 回归模型分析 POAF 与主要不良心脏事件（MACE）的关系。

结果

本研究 POAF 的发生率为 15.15%。POAF 组患者 ICU 再入住（2 例：2 例=8.0%：1.4%，P=0.049）、肾衰竭（2 例：1 例=8.0%：0.7%，P=0.018）和死亡（1 例：0 例=4.0%：0%，P=0.018）的风险显著较高。二项逻辑回归显示，性别（男性）和年龄是 POAF 的独立危险因素（P=0.038，95%置信区间 1.082-16.286；P=0.011，95%置信区间 1.015-1.117），术前使用 ACEI 或 ARB 是 POAF 的保护因素（P=0.010，95%置信区间 0.113-0.748）。5 年随访时，两组的总体 MACE 发生率无统计学差异（P=0.067）。