Amiodarone Versus Propafenone to Treat Atrial Fibrillation after Coronary Artery Bypass Grafting: A Randomized Double Blind Controlled Trial

BACKGROUND: Atrial fibrillation (AF) is one of the most common complications after cardiac surgery. Several therapeutic and preventive strategies have been introduced for postoperative AF, but the treatment and prophylaxis of AF remain controversial. We aimed to compare the efficacy of intravenous amiodarone and oral propafenone in the treatment of AF after coronary artery bypass grafting (CABG). METHODS: This was a randomized controlled trial performed in two hospitals in Shiraz, Iran from 2009 to 2012. We included all patients who underwent elective CABG and developed AF postoperatively. The patients were randomly assigned to receive propafenone or amiodarone. The duration of AF, the success rate of the treatment, the need for cardioversion, the frequency of repeated AF, and the need for repeating the treatment were compared. RESULTS: The duration of the first (p=0.361), second (p=0.832), and third (p=0.298) episodes of AF, the need for cardioversion (p=0.998), and the need to repeat the first and second doses of drugs (p=0.557, 0.699) were comparable between the study groups. Repeated AF was observed in 17 patients (30.9%) in the propafenone group and 23 patients (34.3%) in the amiodarone group (p=0.704). CONCLUSION: Oral propafenone and intravenous amiodarone are equally effective in the treatment and conversion of recent-onset AF after CABG.

Outcome and Graft Patency in Coronary Artery Bypass Grafting with Coronary Endarterectomy

BACKGROUND: Controversy persists regarding the use of coronary endarterectomy (CE) in patients with severe coronary artery disease. We compared the comorbidities and perioperative characteristics of patients undergoing coronary artery bypass grafting (CABG) with and without CE. METHODS: This study was performed in two private hospitals in Shiraz, Iran from May 2010 to December 2011 on 967 patients who underwent CABG without CE and 84 patients who underwent CABG with CE (the CE+ group). After follow-up at 9.66+/-3.65 months post-surgery, 28 patients from the CE+ group underwent angiography to evaluate the patency of grafts and native coronary vessels. RESULTS: Patients in the CE+ group had a more prevalent history of diabetes (48% vs. 36%) and number of diseased vessels (2.88+/-0.39 vs. 2.70+/-0.85). The overall hospital mortality was 1.8%, and no significant difference was observed between the two groups. In the 28 patients who underwent reangiography, 113 vessels were bypassed and 29 endarterectomies were performed, mostly on the left anterior descending artery (12 endarterectomies) and the right coronary artery (8 endarterectomies). In the endarterectomized vessels, a 66% patency rate was found in both the grafts and the native vessels. The native coronary vessels were more likely to be patent when the left internal mammary artery was used as a conduit than when a saphenous vein bypass graft was used. CONCLUSION: The lack of a significant difference in postoperative complications in patients who underwent CABG with or without CE may indicate that CE does not expose patients to a higher risk of complications. Since most of the endarterectomized vessels were shown to be patent during the follow-up period, we propose that endarterectomy is a viable option for patients with severely diseased vessels.

Effects of seasonal variations on the outcome of coronary artery bypass graft surgery

Background: For all the reports on the association between seasons and coronary artery disease, there is a paucity of information on the possible effects of seasonal variations on the outcome of patients after coronary artery bypass grafting surgery [CABG]. The aim of this study was to assess the short-term outcome of post-CABG patients in the four different seasons to find any correlation between seasonal variations and the outcome of such patients

Methods: Data on patients who underwent cardiac surgery between 2007 and 2009 were analyzed. In-hospital mortality, length of Intensive Care Unit [ICU] stay, and length of hospital stay in the four different seasons were considered as outcome measures. The EuroSCORE was calculated for all the patients, and the Kruskal-Wallis, Mann-Whitney, Student t, and chi square tests were used as appropriate

Results: Of a total of 402 patients, who underwent CABG during the mentioned period, 292 patients were male [M/F ratio=2.65]. There were no differences in terms of mean age, sex ratio, and mean EuroSCORE of the patients between the seasons. The mean length of ICU stay was significantly more in the spring than that of the other seasons [P<0.001], while the difference between the four seasons regarding the mean length of hospital stay did not constitute statistical significance [P=0.22]. No effect of seasonal variations was found for the lengths of ICU and hospital stay in the presence of the EuroSCORE after multiple logistic regression analysis [P=0.278, 0.431]

Conclusion: Psychological mood changes caused by regional cultural differences rather than environmental factors should be considered in the optimal management of patients after CABG