Ballas Christos, Katsouras Christos S, Tourmousoglou Christos, Siaravas Konstantinos C, Tzourtzos Ioannis, Alexiou Christos
Department of Cardiac Surgery, University Hospital of Ioannina, 45500 Ioannina, Greece.
1st Department of Cardiology, University Hospital of Ioannina, 45500 Ioannina, Greece.
Biomolecules. 2025 Mar 5;15(3):374. doi: 10.3390/biom15030374.
Postoperative atrial fibrillation (POAF) is the most common arrhythmia following cardiac surgery. This review critically explores the interplay between cardiopulmonary bypass (CPB) and aortic cross-clamping (ACC) times in POAF development. CPB disrupts systemic homeostasis by inducing inflammatory cascades, oxidative stress, and ischemia-reperfusion injury. Prolonged ACC times further exacerbate myocardial ischemia and structural remodeling, with durations exceeding 60-75 min consistently linked to an increased POAF risk. However, variability in outcomes across studies reveals the complex, multifactorial nature of POAF pathogenesis. Patient-specific variables, such as baseline comorbidities and myocardial protection strategies, modulate these risks, emphasizing the need for personalized surgical approaches. Despite advancements in myocardial protection techniques and anti-inflammatory strategies, the incidence of POAF remains persistently high, indicating a gap in translating mechanistic insights into effective interventions. Emerging biomarkers, including microRNAs (e.g., miR-21, miR-483-5p, etc.) and markers of myocardial injury like troponin I, offer potential for enhanced risk stratification and targeted prevention. However, their clinical applicability requires further validation in diverse patient populations. This review underscores the critical need for integrative research that combines clinical, molecular, and procedural variables to elucidate the nuanced interplay of factors driving POAF. Future directions include leveraging advanced intraoperative monitoring tools, refining thresholds for CPB and ACC times, and developing individualized perioperative protocols.
术后心房颤动（POAF）是心脏手术后最常见的心律失常。本综述批判性地探讨了体外循环（CPB）时间和主动脉阻断（ACC）时间在POAF发生过程中的相互作用。CPB通过引发炎症级联反应、氧化应激和缺血再灌注损伤来破坏全身内环境稳定。延长的ACC时间会进一步加剧心肌缺血和结构重塑，持续时间超过60 - 75分钟一直与POAF风险增加相关。然而，各研究结果的差异揭示了POAF发病机制的复杂性和多因素性质。患者特异性变量，如基线合并症和心肌保护策略，会调节这些风险，强调了个性化手术方法的必要性。尽管心肌保护技术和抗炎策略取得了进展，但POAF的发生率仍然居高不下，这表明在将机制性见解转化为有效干预措施方面存在差距。新兴的生物标志物，包括微小RNA（如miR - 21、miR - 483 - 5p等）和心肌损伤标志物如肌钙蛋白I，为加强风险分层和靶向预防提供了潜力。然而，它们的临床适用性需要在不同患者群体中进一步验证。本综述强调了整合研究的迫切需求，该研究结合临床、分子和手术变量，以阐明驱动POAF的因素之间细微的相互作用。未来的方向包括利用先进的术中监测工具、完善CPB和ACC时间的阈值，以及制定个性化的围手术期方案。
