The clinical course of new-onset atrial fibrillation after elective aortic operations.

BACKGROUND: The onset of atrial fibrillation (AFIB) in the postoperative setting has been associated with increased morbidity and mortality in patients undergoing major noncardiothoracic operations. The purpose of this study was to determine the incidence, associated complications, and outcomes of AFIB after open aortic operations. STUDY DESIGN: We studied 211 consecutive patients undergoing elective aortic operations at a single hospital during a recent 6-year period. Postoperatively all patients had continuous ECG monitoring in the ICU for a mean (+/- SD) of 6 +/- 8 days and routine cardiac enzyme determinations. RESULTS: AFIB developed in 22 of the 211 patients (10%), a mean (+/- SD) of 2 +/- 1 days after operation, and it lasted for a mean of 4 +/- 6 days after onset. Sixteen patients spontaneously reverted to normal sinus rhythm, 3 required cardioversion (2 chemical, 1 electrical), and 3 continued in AFIB at discharge. Four of the 22 patients suffered additional cardiac complications, including antecedent MI in 3 (14%) and sustained cardiogenic shock requiring electrical cardioversion in 1. By comparison, the incidence of MI in the other 189 patients was 4% (no significant difference [NSD]). There were no deaths in the AFIB patients. Cardiac emboli developed in none of the 22 patients, and all patients had normal sinus rhythm on ECG obtained a mean of 14 +/- 10 months after discharge. Comparing the 22 patients with AFIB with the 189 patients without AFIB, there were no differences in the mean duration of ICU stay (6 +/- 4 versus 6 +/- 8 days), total length of hospital stay (10 +/- 5 versus 11 +/- 10 days), or hospital mortality (0% versus 0.5%). AFIB patients were older (71 versus 66 years, p = 0.016), but there was no difference in gender or use of beta-blockers between the two groups. CONCLUSIONS: These data suggest that AFIB is not uncommon after aortic operations but is not associated with increased morbidity, mortality, or length of hospital stay. Although a minority of affected patients can have other cardiac complications such as MI, these complications are usually recognized before the onset of AFIB. AFIB does not affect the outcomes of aortic operations. Most patients will revert spontaneously to normal sinus rhythm and do not require longterm anticoagulation to prevent thromboembolic complications.

Repair of a saccular aortic aneurysm with superficial femoral-popliteal vein in the presence of a pancreatic abscess.

When one is faced with impending rupture, repair of an aortic aneurysm cannot be delayed. In the presence of coexisting intra-abdominal sepsis, traditional therapy would call for aneurysm exclusion and axillofemoral bypass grafting. Consequences of this choice of treatment include limited long-term graft patency and recurrent prosthetic infection. Autogenous deep veins from the lower extremities have demonstrated exceptional patency and resilience to infection when used to replace infected aortic grafts. We now report a case of concomitant open drainage of a pancreatic abscess and repair of a saccular abdominal aortic aneurysm using the superficial femoral-popliteal vein as a conduit.

Prevention of venous thromboembolism.

Venous thromboembolism is a preventable cause of morbidity and death in hospitalized patients. In addition to administering correct and effective prophylaxis to the various treatment groups, therapy should be tailored to the individual based on the identification of baseline risk factors. No patient at significant risk for venous thrombosis should be left unprotected.