Predictors of post-operative atrial fibrillation in patients undergoing isolated coronary artery bypass grafting.

BACKGROUND: Post-operative atrial fibrillation (POAF) is the most common cardiac arrhythmia occurring after coronary artery bypass grafting (CABG). Arrhythmia leads to prolonged hospitalisation and may have an impact on both short-term and long-term prognoses. AIM: The aim of this paper was to evaluate the incidence of POAF in patients after CABG as well as to identify its predictors. METHODS: The study was performed on 791 patients (selected from a group of 1031 patients who underwent CABG in the Clinical Department of Cardiology in the years 2009-2011) who did not suffer from atrial fibrillation (AF) prior to isolated CABG. Data on co-existing diseases, as well as data collected at the time of surgery and in the post-operative period, were evaluated. RESULTS: The average age of patients in the examined group was 64.6 ± 9.1 years. Emergency CABG was performed on 38% of patients, whereas 75.1% of patients underwent CABG with the use of extracorporeal circulation. Based on the incidence of POAF, the post-CABG patients were classified into a POAF(+) group that comprised 166 (21%) patients, and a POAF(-) group involving 625 (79%) patients. The first occurrence of arrhythmia during the first three days after surgery was observed in 76.5% of patients. The average age of POAF(+) and POAF(-) patients was 68.7 ± 8.8 years and 63.5 ± 8.9 years, respectively (p < 0.0001). The respective incidence rates of co-existing diseases in patients with POAF and those without POAF were as follows: arterial hypertension, 80.1% vs. 75.8% (p = 0.29); heart failure, 18.7% vs. 21.1% (p = 0.56); type 2 diabetes, 24.1% vs. 26.2% (p = 0.64). Stable angina pectoris was diagnosed in 22.3% of patients with POAF and 15% of patients without POAF (p = 0.034). The following conditions were more frequently observed in patients with POAF compared with those without POAF: low cardiac output syndrome, 28.9% vs. 14.2% (p < 0.0001) and cardiac tamponade, 9% vs. 4.6% (p = 0.044), respectively. Red blood cell transfusions were performed more often in patients with POAF compared to those without POAF (70.5% vs. 55.7%, respectively, p = 0.0008). Multivariate analysis revealed the following potential predictors of POAF: age ≥ 70 years (HR 2.3), preoperative stable angina pectoris (HR 1.7), and post-CABG low cardiac output syndrome (HR 1.8). CONCLUSIONS: POAF was diagnosed in 21% of post-CABG patients, and the major predictors were: age ≥ 70 years, preoperative stable angina, as well as low cardiac output syndrome following CABG.

Simultaneous removal of a tumour of the right atrium and inferior vena cava and coronary bypass-grafting in a patient with recurrent clear renal cell carcinoma.

Metastatic cardiac tumours are the most common malignant cardiac tumours. In the early stages they are usually asymptomatic, but their consequences can be very serious, and the prognosis is poor. We present a patient with recurrent renal cell carcinoma as a tumour of the right atrium and the vena cava inferior in whom cancerous masses were removed with simultaneously coronary artery bypass-grafting.

Coronary artery bypass grafting in patients over 80 years of age: a single-centre experience.

BACKGROUND: Extended length of human life leads to an increased number of the elderly with coronary artery disease. Advanced age does not constitute a contra indication for surgical revascularisation. However, as reflected by the available risk scores, mortality risk associated with operating patients in the 9th decade of life is increased. AIM: To characterise patients over 80 years of age undergoing coronary artery bypass grafting (CABG) and to evaluate in-hospital mortality in the study group. METHODS: We retrospectively analysed medical records of 51 patients over 80 years of age who underwent CABG in a cardiacsurgical department of a regional cardiology centre in 2008-2011. The following factors were taken into consideration: coexisting diseases, laboratory test results, echocardiographic findings, surgical data, and in-hospital mortality. EuroSCORE (European System for Cardiac Operative Risk Evaluation) I and EuroSCORE II risk scores were used for preoperative risk assessment. RESULTS: The mean age in the study group was 81.7 years. Coexisting diseases included hypertension in 76.5% of patients, impaired renal function in 62.7% of patients, heart failure in 31.4% of patients, atrial fibrillation (AF) in 21.6% of patients, and diabetes mellitus in 15.7% of patients. Most patients had a history of myocardial infarction (MI). CABG was performed using cardiopulmonary bypass in 51.6% of patients. The most frequent complications were new onset AF which occurred in 41.2% of operated patients and low cardiac output syndrome which was observed in 37.3% of patients. In-hospital mortality rate among patients over 80 years of age undergoing CABG was 3.9%, lower than predicted by the logistic EuroSCORE I (9.1%) and EuroSCORE II (7.3%). Two patients died during the postoperative period, including one operated with the use of cardiopulmonary bypass. CONCLUSIONS: The most common concomitant conditions in the elderly patients undergoing cardiac surgery are hypertension and impaired renal function. The majority of operated patients already suffered a MI. AF and low cardiac output syndrome are the most common postoperative complications. Among patients above 80 years of age, operative mortality risk predicted using the EuroSCORE I and EuroSCORE II may be overestimated. Patient selection for cardiac surgery must be based on individual factors, taking into account the feasibility of postoperative rehabilitation and the potential for improved survival and quality of life.

[Depression in patients after coronary artery bypass grafting]. / Depresja u chorych po pomostowaniu aortalno-wienowym.

Surgical revascularization is a recognized method of treatment ofischaemic heart disease. The number of patients undergoing coronary artery bypass grafting (CABG) is constantly increasing, both in a population of young patients with coronary heart disease and in elderly patients. It is estimated that even one out of three patients undergoing CABG in the perioperative period can develop symptoms of depression. Numerous individual factors as well as factors related to the surgery have an impact on the occurrence of depression. The most common factors are: age, sex, socio-economic status, co-existing diseases, and the occurrence ofpreoperative depression. Researchers are currently looking for biochemical markers concentration of which before surgery could serve as a predicator for the occurrence of post-CABG depression. It is suggested that inflammatory response, particularly intense in the perioperative period, is linked to the occurrence of depression after surgical revascularization. Recognizing these factors is of utmost importance since it will help develop a stratification aiming at the identification of patients who are particularly prone to the occurrence of postoperative depression. Due to the fact that depression not only lowers the quality of life but also affects the short-term and long-term prognosis, identifying patients at risk is significantly important.