Relation between preoperative mild increased in serum creatinine level and early outcomes after coronary artery bypass grafting

This study evaluates the effect of preoperative increased level of serum creatinine [Cr] on early outcomes after coronary artery bypass graft surgery [CABG]. 1140 patients who underwent CABG in our center were studied. Patients with Cr >2.25 mg/dl or preoperative dialysis and who had off-pump operations were excluded. Group 1 consisted of 892 patients with normal Cr [0.5-1.2 mg/dl] and group 2 consisted of 248 [21.8%] patients with mild increased level of serum Cr [1.3-2.2 mg/dl]. Patients in group 1 were younger than group 2. There were more patients with hypertension in group 2, but there were not statistically significant difference between two groups in terms of the frequency of diabetes, smoking, cerebrovascular disease and New York Heart Association [NYHA] class. Left ventricular ejection fraction [LVEF] was lower in group 2. Cardiopulmonary bypass time [CPB] was longer in group 2. Early mortality was 3.2% in group 1 and 8.4% in group 2 [P<0.001]. Prolonged ICU stay, low cardiac output, prolonged mechanical ventilation, postoperative atrial fibrillation, postoperative re-exploration and sepsis were more frequent in group 2. Mild increase in serum Cr level preoperatively is a marker of increased early mortality and outcome after CABG

Relationship between blood transfusion and increased risk of atrial fibrillation after coronary artery bypass graft surgery

New-onset atrial fibrillation [AF] after cardiac surgery contributes to increased morbidity, hospital length of stay, and resource utilization. Although many aspects of AF after cardiac surgery have already been elucidated, the mechanism by which cardiac surgery predisposes patients to AF has hitherto remained unknown. Recent evidence supports the notion that blood transfusion enhances the inflammatory response, thereby increasing the incidence of post-operative AF. This retrospective study was conducted on 2095 patients who underwent coronary artery bypass grafting [CABG] alone or accompanied by valve surgery between January 2005 and July 2007. Variables associated with the development of new-onset AF were identified using logistic regression. Intensive care unit blood transfusion increased the risk of AF [odds ratio per unit transfused, 1.16; 95% confidence limits, 1.14, 1.24; P<0.001]. Blood transfusion was performed in 487 patients and was associated with a significant increase in new-onset of AF [45.9% vs. 37.9%; P < 0.01]. Homologous blood transfusion can increase the incidence of new-onset AF after CABG. This factor should be considered in identifying patients who might benefit from prophylaxis in order to prevent this common post-operative complication and the adverse consequences thereof