Hakan DİNÇKAL, Adil POLAT, İrfan ŞAHİN, İmran ÖNÜR, Vedat ERENTUĞ, Cihan YÜCEL

Coronary vasculature and postoperative atrial fibrillation: a risk factor analysis

Amaç: Bu çalışmada koroner arter baypas greft (KABG) ameliyatlarının sonuçları, ameliyat sonrası atriyal fibrilasyon, koroner damar yapısı ve koroner arter hastalığının şekli ve genişliği ile ilişkisi açısından incelendi.Çalışma planı: Ocak 2011 ve Mayıs 2011 tarihleri arasında kliniğimizde ameliyat edilen ardışık 94 KABG hastası (68 erkek, 26 kadın; ort. yaş 61.4±10.9 yıl; aralık 38-87 yıl) bu prospektif gözlem çalışmasına alındı. Ameliyat sonrası atriyal fibrilasyon gelişimini etkileyen faktörler için lojistik regresyon analizi yapıldı. Bağımsız değişkenler olarak ameliyat sırası parametreler (Gensini skoru, Rentrop skoru, revaskülarize edilen damar sayısı, dominant koroner arter sistemi, dominant koroner arter sisteminin revaskülarizasyonu, sol ana koroner arter hastalığı, başvuru zamanı klinik tablosu, sol ventrikül disfonksiyonu ve sol atriyum çapı) analiz edildi.Bulgular: Ameliyat sırası 23 hastada (%24.5) atriyal fibrilasyon gelişti. Yirmi hasta amiodaron tedavisi ile normal sinüs ritmine döndürüldü. Üç hastada (%3.2) hastane mortalitesi oldu. Atriyal fibrilasyon gelişen ve gelişmeyen hastalarda mortalite oranları açısından istatistiksel olarak anlamlı bir fark yoktu. Sol ventrikül disfonksiyonu (p=0.034) ve sol ana koroner arter hastalığı (p=0.019) ameliyat sonrası atriyal fibrilasyon gelişimi ile anlamlı olarak ilişkiliydi. Renal komplikasyon oranı (p=0.030) ve sternal revizyon cerrahisi gerekliliği (p=0.003) açısından iki grup arasında anlamlı bir farklılık yoktu.Sonuç: Ameliyat sonrası atriyal fibrilasyon kalp cerrahisinde sık karşılaşılan bir komplikasyondur. Sol ventrikül disfonksiyonu, ameliyat sonrası atriyal fibrilasyon gelişimi açısından anlamlı bir risk faktörüdür. Koroner damar yapısı ve atriyal fibrilasyon gelişimi arasında anlamlı bir ilişki olmasa da, sol ana koroner arter hastalığı ameliyat sonrası atriyal fibrilasyon için ciddi bir risk faktörüdür.

Koroner damar yapısı ve ameliyat sonrası atriyal fibrilasyon: Risk faktör analizi

Background: This study aims to investigate the results of coronary artery bypass graft (CABG) surgeries in terms of the relation of postoperative atrial fibrillation, coronary vasculature, and the nature and extent of coronary artery disease.Methods: Between January 2011 and May 2011, 94 consecutive CABG patients (68 males, 26 females; mean age 61.4±10.9 years; range 38 to 87 years) who were operated in our clinic were enrolled in this prospective observational study. Logistic regression analysis was performed for the factors influencing the occurrence of postoperative atrial fibrillation. The perioperative parameters (Gensini score, Rentrop score, number of revascularized vessels, dominant coronary artery system, revascularization of the dominant coronary artery system, left main coronary artery disease, clinical status on admission, left ventricular dysfunction, and left atrium diameter) were analyzed as independent variables.Results: Twenty-three patients (24.5%) developed perioperative atrial fibrillation. Twenty patients returned to normal sinus rhythm with amiodarone therapy. In-hospital mortality was observed in three patients (3.2%). There was no statistically significant difference in mortality rates among the patients with and without atrial fibrillation. Left ventricular dysfunction (p=0.034) and left main coronary artery disease (p=0.019) were found to be significantly associated with the occurrence of postoperative atrial fibrillation. The rate of renal complications (p=0.030) and the need for sternal revision surgery (p=0.003) were not significantly different between both groups.Conclusion: Postoperative atrial fibrillation is a frequently encountered complication of cardiac surgery. The left ventricular dysfunction is a significant risk factor for postoperative occurrence of atrial fibrillation. Although no significant association between coronary vasculature and atrial fibrillation, the left main coronary artery disease is a serious risk factor for postoperative atrial fibrillation.

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