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Liblik K, Zucker J, Baranchuk A, Fernandez AL, Zhang S, Diasty ME. The role of pericardial fluid biomarkers in predicting post-operative atrial fibrillation, a comprehensive review of current literature. Trends Cardiovasc Med 2024; 34:244-247. [PMID: 36863643 DOI: 10.1016/j.tcm.2023.02.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2022] [Revised: 02/06/2023] [Accepted: 02/23/2023] [Indexed: 03/04/2023]
Abstract
Post-operative atrial fibrillation (POAF) is a common complication of cardiac surgery which is associated with longer hospital stay, diminished quality of life, and increased mortality. Yet, the pathophysiology of POAF is poorly understood and it is unclear which patients are at highest risk. Pericardial fluid (PCF) analysis is emerging as an important tool for the early detection of biochemical and molecular changes in the cardiac tissue. With the epicardium acting as a semi-permeable membrane, the composition of PCF reflects the activity of the cardiac interstitium. Emerging research on PCF composition has identified promising biomarkers which may help stratify the risk for developing POAF. These include inflammatory molecules, such as interleukin-6, mitochondrial deoxyribonucleic acid, and myeloperoxidase, as well as natriuretic peptides. Additionally, PCF appears to be superior to serum analysis in detecting changes in these molecules during the early postoperative period after cardiac surgery. The aim of the present narrative review is to summarize the current literature on the temporal changes in the levels of potential biomarkers in PCF after cardiac surgery and their association with the development of new-onset postoperative atrial fibrillation.
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Affiliation(s)
- Kiera Liblik
- Division of Cardiac Surgery, Queen's University, Kingston, ON, Canada
| | - James Zucker
- Division of Cardiac Surgery, Queen's University, Kingston, ON, Canada
| | - Adrian Baranchuk
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada
| | | | - Shetuan Zhang
- Division of Cardiology, Department of Medicine, Queen's University, Kingston, ON, Canada; Department of Biomedical and Molecular Sciences, Queen's University, Kingston, ON, Canada
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Halonen J, Kärkkäinen J, Jäntti H, Martikainen T, Valtola A, Ellam S, Väliaho E, Santala E, Räsänen J, Juutilainen A, Mahlamäki V, Vasankari S, Vasankari T, Hartikainen J. Prevention of Atrial Fibrillation After Cardiac Surgery: A Review of Literature and Comparison of Different Treatment Modalities. Cardiol Rev 2024; 32:248-256. [PMID: 36729126 DOI: 10.1097/crd.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Atrial fibrillation is the most common arrhythmia to occur after cardiac surgery, with an incidence of 10% to 50%. It is associated with postoperative complications including increased risk of stroke, prolonged hospital stays and increased costs. Despite new insights into the mechanisms of atrial fibrillation, no specific etiologic factor has been identified as the sole perpetrator of the arrhythmia. Current evidence suggests that the pathophysiology of atrial fibrillation in general, as well as after cardiac surgery, is multifactorial. Studies have also shown that new-onset postoperative atrial fibrillation following cardiac surgery is associated with a higher risk of short-term and long-term mortality. Furthermore, it has been demonstrated that prophylactic medical therapy decreases the incidence of postoperative atrial fibrillation after cardiac surgery. Of note, the incidence of postoperative atrial fibrillation has not changed during the last decades despite the numerous preventive strategies and operative techniques proposed, although the perioperative and postoperative care of cardiac patients as such has improved.
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Affiliation(s)
- Jari Halonen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jussi Kärkkäinen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Helena Jäntti
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
- Centre for Prehospital Emergency Care, Kuopio University Hospital, Kuopio, Finland
| | - Tero Martikainen
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Antti Valtola
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
| | - Sten Ellam
- Department of Anesthesiology and Operative Services, Kuopio University Hospital, Kuopio, Finland
| | - Eemu Väliaho
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Elmeri Santala
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Jenni Räsänen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Auni Juutilainen
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Visa Mahlamäki
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
| | - Sini Vasankari
- Department of Clinical Medicine, University of Turku, Turku, Finland
| | - Tommi Vasankari
- The UKK Institute for Health Promotion Research, Tampere, Finland
- The Faculty of Medicine and Health Technology, Tampere University, Tampere, Finland
| | - Juha Hartikainen
- From the Heart Center, Kuopio University Hospital, Kuopio, Finland
- Institute of Clinical Medicine, School of Medicine, University of Eastern Finland, Kuopio, Finland
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Zhang L, Li X, Wu H, Luo J. Risk factors associated with atrial fibrillation following lung cancer surgery: A multi-center case-control study. Asian J Surg 2024; 47:176-183. [PMID: 37419802 DOI: 10.1016/j.asjsur.2023.06.108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2023] [Revised: 06/12/2023] [Accepted: 06/22/2023] [Indexed: 07/09/2023] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is a common complication after major thoracic operations. The objective of this case-control study was to identify the risk factors for POAF following lung cancer surgery. METHODS In total, 216 patients with lung cancer who were selected from three different hospitals were followed up between May 2020 and May 2022. They were divided into two groups: case group, patients with POAF and control group, patients without POAF (case-control). Risk factors associated with POAF were investigated using univariate and multivariate logistic regression analyses. RESULTS Risk factors that were significantly associated with POAF were preoperative brain-type natriuretic peptide (BNP) levels [odds ratio (OR): 4.46; 95% confidence interval (CI): 1.52-13.06; P = 0.0064], sex (OR: 0.07; 95%CI: 0.02-0.28; P = 0.0001), preoperative white blood cell (WBC) count (OR: 3.00; 95%CI: 1.89-4.77; P < 0.0001), lymph node dissection (OR: 11.49; 95%CI: 2.81-47.01; P = 0.0007), and cardiovascular disease (OR: 4.93; 95%CI: 1.14-21.31; P = 0.0326). CONCLUSION In summary, data from the three hospitals suggested that preoperative BNP levels, sex, preoperative WBC count, lymph node dissection, and hypertension/coronary heart disease/myocardial infarction were associated with a significantly high risk of POAF following lung cancer surgery.
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Affiliation(s)
- Lifu Zhang
- ECG Room, Jiangxi Cancer Hospital, The Second Affiliated Hospital of Nanchang Medical College, Jiangxi Clinical Research Center for Cancer, Nanchang, 330029, China
| | - Xinv Li
- Department of Nephrology, Xinyu People's Hospital, Jiangxi Province, Xinyu, 338000, China
| | - Haifeng Wu
- Department of Respiratory Medicine, Jiangxi Provincial People's Hospital, The First Affiliated Hospital of Nanchang Medical College, Nanchang, 330006, China.
| | - Jie Luo
- Department of Health Care, Jinling Hospital, Medical School of Nanjing University, Nanjing, 210002, China.
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Schreiber T, Grune J, Landmesser U, Attanasio P. Detection and modification of biomarkers of inflammation determining successful rhythm control in patients with atrial fibrillation. Biomarkers 2023; 28:681-691. [PMID: 37962292 DOI: 10.1080/1354750x.2023.2284122] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2023] [Accepted: 11/12/2023] [Indexed: 11/15/2023]
Abstract
INTRODUCTION Multiple pathophysiological mechanisms are involved in the pathogenesis of atrial fibrillation (AF). Growing evidence suggests that both local and systemic inflammation plays a key role even in early stages and its progression towards persisting and permanent AF. Rhythm control therapy via pulmonary vein isolation or cardioversion is the cornerstone of AF therapy for most symptomatic patients, yet arrhythmia recurrence after treatment is still common, especially in patients with persistent AF. MATERIAL AND METHODS In this review, we summarize the current state of knowledge of biomarkers of inflammation with prognostic value in patients with atrial fibrillation as well as anti-inflammatory medication with potential benefits after rhythm control therapy. RESULTS AND DISCUSSION Both onset of AF, progression and arrhythmia recurrence after rhythm control therapy can be caused by local and systemic inflammation. Various inflammatory biomarkers have been established to predict treatment success. Furthermore, additional anti-inflammatory therapy may significantly improve success rates.
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Affiliation(s)
- Tobias Schreiber
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
| | - Jana Grune
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Department of Cardiothoracic and Vascular Surgery, Deutsches Herzzentrum der Charité, Berlin, Germany
- Charité-Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Ulf Landmesser
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
- German Centre for Cardiovascular Research (DZHK), Berlin, Germany
- Berlin Institute of Health (BIH), Berlin, Germany
| | - Philipp Attanasio
- Deutsches Herzzentrum der Charité, Klinik für Kardiologie, Angiologie und Intensivmedizin, Berlin, Germany
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Lu Y, Chen Q, Zhang H, Huang M, Yao Y, Ming Y, Yan M, Yu Y, Yu L. Machine Learning Models of Postoperative Atrial Fibrillation Prediction After Cardiac Surgery. J Cardiothorac Vasc Anesth 2023; 37:360-366. [PMID: 36535840 DOI: 10.1053/j.jvca.2022.11.025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/19/2022] [Revised: 11/06/2022] [Accepted: 11/20/2022] [Indexed: 11/27/2022]
Abstract
OBJECTIVES This study aimed to use machine learning algorithms to build an efficient forecasting model of atrial fibrillation after cardiac surgery, and to compare the predictive performance of machine learning to traditional logistic regression. DESIGN A retrospective study. SETTING Second Affiliated Hospital of Zhejiang University School of Medicine. PARTICIPANTS The study comprised 1,400 patients who underwent valve and/or coronary artery bypass grafting surgery with cardiopulmonary bypass from September 1, 2013 to December 31, 2018. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Two machine learning approaches (gradient-boosting decision tree and support-vector machine) and logistic regression were used to build predictive models. The performance was compared by the area under the curve (AUC). The clinical practicability was assessed using decision curve analysis. Postoperative atrial fibrillation occurred in 519 patients (37.1%). The AUCs of the support-vector machine, logistic regression, and gradient boosting decision tree were 0.777 (95% CI: 0.772-0.781), 0.767 (95% CI: 0.762-0.772), and 0.765 (95% CI: 0.761-0.770), respectively. As decision curve analysis manifested, these models had achieved appropriate net benefit. CONCLUSION In the authors' study, the support-vector machine model was the best predictor; it may be an effective tool for predicting atrial fibrillation after cardiac surgery.
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Affiliation(s)
- Yufan Lu
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China; Department of Anesthesiology, Taizhou Central Hospital (Taizhou University Hospital), Zhejiang, China
| | - Qingjuan Chen
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Hu Zhang
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Meijiao Huang
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Yu Yao
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Yue Ming
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Min Yan
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Yunxian Yu
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China
| | - Lina Yu
- Department of Anesthesiology, Second Affiliated Hospital of Zhejiang University School of Medicine, Zhejiang University, Zhejiang, China.
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Zhou Z, Long Y, He X, Li Y. Effects of different doses of glucocorticoids on postoperative atrial fibrillation: a meta-analysis. BMC Cardiovasc Disord 2023; 23:16. [PMID: 36635657 PMCID: PMC9838011 DOI: 10.1186/s12872-022-03001-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2022] [Accepted: 12/09/2022] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Postoperative atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery, and its occurrence is closely related to inflammation. This paper intends to apply meta-analysis to investigate the effect of glucocorticoids on POAF. METHODS PubMed, Embase, Web of Science, and Cochrane Library were searched using the internationally recognized systematic evaluation and retrieval strategy. Two review authors independently selected relevant studies and extracted data based on the Cochrane handbook for systematic reviews of interventions approach. Stata 17 was used for data analysis. In the subgroup analysis, we grouped the participant data according to differences in glucocorticoids dose and type of surgery. At the same time, we also conducted a meta-analysis on the possible infection and gastrointestinal injury caused by glucocorticoids use. RESULTS 27 studies and 14,442 patients were finally included. Results from the random-effects model indicated that the incidence of POAF was lower in glucocorticoid group (RR 0.80, 95% CI 0.71-0.92, P = 0.001). According to the subgroup analysis result, low doses of glucocorticoids reduced the incidence of POAF (RR 0.81, 95% CI 0.71-0.92, P = 0.001). The effect of high doses glucocorticoids on the POAF was not statistically significant (RR 0.81, 95% CI 0.56-1.19, P = 0.286). In the coronary artery bypass grafting (CABG) subgroup, the glucocorticoids reduced the incidence of POAF (RR 0.71, 95% CI 0.58-0.87, P = 0.001). In the CABG OR Valvular Surgery group, the effect of glucocorticoids on POAF was not statistically significant (RR 0.88, 95% CI 0.75-1.03, P = 0.108). 15 studies documented postoperative complications of infection, two studies were excluded from the system because the end point event was 0, and meta-analysis showed no increased risk of infection from glucocorticoid use (RR 0.85, 95% CI 0.68-1.06, P = 0.158). Eight studies documented the effects of glucocorticoids on gastrointestinal diseases, and meta-analysis showed no differences between the two groups (RR 1.12, 95% CI 0.83-1.50, P = 0.450). CONCLUSION The use of glucocorticoids can reduce the incidence of POAF. The subgroup analysis result showed that low-dose glucocorticoids were more effective than high-dose glucocorticoids in inhibiting POAF. The use of glucocorticoids in CABG alone can better inhibit the occurrence of POAF. The effects of glucocorticoids on infection and gastrointestinal injury were not statistically significant. REVIEW REGISTRATION PROSPERO, CRD42022304521.
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Affiliation(s)
- Zhongzheng Zhou
- Department of Cardiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400025 China
| | - Yi Long
- Department of Cardiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400025 China
| | - Xin He
- Department of Cardiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400025 China
| | - Yong Li
- Department of Cardiology, Chongqing Traditional Chinese Medicine Hospital, Chongqing, 400025 China
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Fleet H, Pilcher D, Bellomo R, Coulson TG. Predicting atrial fibrillation after cardiac surgery: a scoping review of associated factors and systematic review of existing prediction models. Perfusion 2023; 38:92-108. [PMID: 34405746 DOI: 10.1177/02676591211037025] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
Abstract
INTRODUCTION Postoperative atrial fibrillation (POAF) is common after cardiac surgery and associated with increased hospital length of stay, patient morbidity and mortality. We aimed to identify factors associated with POAF and evaluate the accuracy of available POAF prediction models. METHODS We screened articles from Ovid MEDLINE® and PubMed Central® (PMC) and included studies that evaluated risk factors associated with POAF or studies that designed or validated POAF prediction models. We only included studies in cardiac surgical patients with sample size n ⩾ 50 and a POAF outcome group ⩾20. We summarised factors that were associated with POAF and assessed prediction model performance by reviewing reported calibration and discriminative ability. RESULTS We reviewed 232 studies. Of these, 142 fulfilled the inclusion criteria. Age was frequently found to be associated with POAF, while most other variables showed contradictory findings, or were assessed in few studies. Overall, 15 studies specifically developed and/or validated 12 prediction models. Of these, all showed poor discrimination or absent calibration in predicting POAF in externally validated cohorts. CONCLUSIONS Except for age, reporting of factors associated with POAF is inconsistent and often contradictory. Prediction models have low discrimination, missing calibration statistics, are at risk of bias and show limited clinical applicability. This suggests the need for studies that prospectively collect AF relevant data in large cohorts and then proceed to validate findings in external data sets.
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Affiliation(s)
- Hugh Fleet
- Melbourne Medical School, The University of Melbourne, Melbourne, VIC, Australia
| | - David Pilcher
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
| | - Rinaldo Bellomo
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, VIC, Australia
| | - Tim G Coulson
- Department of Epidemiology and Preventative Medicine, Monash University, Melbourne, VIC, Australia
- Centre for Integrated Critical Care, The University of Melbourne, Parkville, VIC, Australia
- Department of Anaesthesia, Austin Hospital, Melbourne, VIC, Australia
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Zhou Y, Wu Q, Ni G, Hong Y, Xiao S, Liu C, Yu Z. Immune-associated pivotal biomarkers identification and competing endogenous RNA network construction in post-operative atrial fibrillation by comprehensive bioinformatics and machine learning strategies. Front Immunol 2022; 13:974935. [PMID: 36341343 PMCID: PMC9630466 DOI: 10.3389/fimmu.2022.974935] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/21/2022] [Accepted: 10/10/2022] [Indexed: 11/13/2022] Open
Abstract
Background Atrial fibrillation (AF) is the most common arrhythmia. Previous studies mainly focused on identifying potential diagnostic biomarkers and treatment strategies for AF, while few studies concentrated on post-operative AF (POAF), particularly using bioinformatics analysis and machine learning algorithms. Therefore, our study aimed to identify immune-associated genes and provide the competing endogenous RNA (ceRNA) network for POAF. Methods Three GSE datasets were downloaded from the GEO database, and we used a variety of bioinformatics strategies and machine learning algorithms to discover candidate hub genes. These techniques included identifying differentially expressed genes (DEGs) and circRNAs (DECs), building protein-protein interaction networks, selecting common genes, and filtering candidate hub genes via three machine learning algorithms. To assess the diagnostic value, we then created the nomogram and receiver operating curve (ROC). MiRNAs targeting DEGs and DECs were predicted using five tools and the competing endogenous RNA (ceRNA) network was built. Moreover, we performed the immune cell infiltration analysis to better elucidate the regulation of immune cells in POAF. Results We identified 234 DEGs (82 up-regulated and 152 down-regulated) of POAF via Limma, 75 node genes were visualized via PPI network, which were mainly enriched in immune regulation. 15 common genes were selected using three CytoHubba algorithms. Following machine learning selection, the nomogram was created based on the four candidate hub genes. The area under curve (AUC) of the nomogram and individual gene were all over 0.75, showing the ideal diagnostic value. The dysregulation of macrophages may be critical in POAF pathogenesis. A novel circ_0007738 was discovered in POAF and the ceRNA network was eventually built. Conclusion We identified four immune-associated candidate hub genes (C1QA, C1R, MET, and SDC4) for POAF diagnosis through the creation of a nomogram and evaluation of its diagnostic value. The modulation of macrophages and the ceRNA network may represent further therapy methods.
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Affiliation(s)
- Yufei Zhou
- Department of Cardiology, Zhongshan Hospital, Fudan University, Shanghai, China
| | - Qianyun Wu
- Department of Cardiology, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Suzhou, China
| | - Gehui Ni
- Department of Cardiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Yulu Hong
- Department of Computer Science and Technology, Central South University, Changsha, China
| | - Shengjue Xiao
- Department of Cardiology, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, China
| | - Chunjiang Liu
- Department of General Surgery, Shaoxing People’s Hospital (Shaoxing Hospital of Zhejiang University), Shaoxing, China
| | - Zongliang Yu
- Department of Cardiology, The First People’s Hospital of Kunshan Affiliated to Jiangsu University, Suzhou, China
- *Correspondence: Zongliang Yu,
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Yang H, Yuan C, Yang J, Xiang H, Lan W, Tang Y. A novel predictive model for new-onset atrial fibrillation in patients after isolated cardiac valve surgery. Front Cardiovasc Med 2022; 9:949259. [PMID: 36247462 PMCID: PMC9556269 DOI: 10.3389/fcvm.2022.949259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2022] [Accepted: 08/15/2022] [Indexed: 11/13/2022] Open
Abstract
BackgroundPostoperative atrial fibrillation (POAF) is a severe complication after cardiac surgery and is associated with an increased risk of ischemic stroke and mortality. The main aim of this study was to identify the independent predictors associated with POAF after isolated valve operation and to develop a risk prediction model.MethodsThis retrospective observational study involved patients without previous AF who underwent isolated valve surgery from November 2018 to October 2021. Patients were stratified into two groups according to the development of new-onset POAF. Baseline characteristics and perioperative data were collected from the two groups of patients. Univariate and multivariate logistic regression analyses were applied to identify independent risk factors for the occurrence of POAF, and the results of the multivariate analysis were used to create a predictive nomogram.ResultsA total of 422 patients were included in the study, of which 163 (38.6%) developed POAF. The Multivariate logistic regression analysis indicated that cardiac function (odds ratio [OR] = 2.881, 95% confidence interval [CI] = 1.595–5.206; P < 0.001), Left atrial diameter index (OR = 1.071, 95%CI = 1.028–1.117; P = 0.001), Operative time (OR = 1.532, 95%CI = 1.095–2.141; P = 0.013), Neutrophil count (OR = 1.042, 95%CI = 1.006–1.08; P = 0.021) and the magnitude of fever (OR = 3.414, 95%CI = 2.454–4.751; P < 0.001) were independent predictors of POAF. The above Variables were incorporated, and a nomogram was successfully constructed with a C-index of 0.810. The area under the receiver operating characteristic curve was 0.817.ConclusionCardiac function, left atrial diameter index, operative time, neutrophil count, and fever were independent predictors of POAF in patients with isolated valve surgery. Establishing a nomogram model based on the above predictors helps predict the risk of POAF and may have potential clinical utility in preventive interventions.
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Affiliation(s)
- Heng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Chen Yuan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Juesheng Yang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Haiyan Xiang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
| | - Wanqi Lan
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- The Second Clinical Medical College of Nanchang University, Nanchang, China
| | - Yanhua Tang
- Department of Cardiovascular Surgery, The Second Affiliated Hospital of Nanchang University, Nanchang, China
- *Correspondence: Yanhua Tang,
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Raczkowska-Golanko M, Młodziński K, Raczak G, Gruchała M, Daniłowicz-Szymanowicz L. New-Onset Atrial Fibrillation in Acute Myocardial Infarction Is a Different Phenomenon than Other Pre-Existing Types of That Arrhythmia. J Clin Med 2022; 11:4410. [PMID: 35956027 PMCID: PMC9369347 DOI: 10.3390/jcm11154410] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2022] [Revised: 07/25/2022] [Accepted: 07/27/2022] [Indexed: 02/04/2023] Open
Abstract
(1) Background: Atrial fibrillation (AF) in acute myocardial infarction (AMI) could worsen the prognosis. Yet, there is no definitive answer to whether new-onset AF (NOAF) is a more aggravating diagnosis than other types of that arrhythmia. The purpose of our study was to compare in-hospital clinical course and outcomes of NOAF patients contrary to patients with other pre-existing types of AF. (2) Methods: AMI patients hospitalized in the high-volume cardiological center within 2017−2018 were included in the study. NOAF was noticed in 106 (11%) patients, 95 (10%) with an AF history and AF during AMI formed the AF group, 60 (6%) with an AF history but without AF during AMI constituted the Prior-AF group, and 693 (73%) patients were without an AF before and during AMI. Medical history, routinely monitored clinical parameters, and in-hospital outcomes were analyzed between the groups. (3) Results: NOAF patients, contrary to others, initially had the highest high-sensitivity troponin I (hsTnI), B-type natriuretic peptide (BNP), C-reactive protein (CRP), and glucose levels, and the lowest potassium concentration, with the worst profile of changes for that parameter within the first four days of hospitalization. NOAF patients had the highest rate of ST-elevated AMI (40%), the longest hospitalization (p < 0.001), and the highest in-hospital mortality (p < 0.001). Not NOAF, but other AF groups (AF and Prior-AF groups) were more burdened with the previous comorbidities. (4) Conclusions: NOAF could be a distinct phenomenon in AMI patients, identifying those with the worst clinical in-hospital course and outcomes as compared to other types of AF.
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Affiliation(s)
- Monika Raczkowska-Golanko
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.R.-G.); (K.M.); (G.R.)
| | - Krzysztof Młodziński
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.R.-G.); (K.M.); (G.R.)
| | - Grzegorz Raczak
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.R.-G.); (K.M.); (G.R.)
| | - Marcin Gruchała
- First Department of Cardiology, Medical University of Gdańsk, 80-211 Gdańsk, Poland;
| | - Ludmiła Daniłowicz-Szymanowicz
- Department of Cardiology and Electrotherapy, Medical University of Gdansk, 80-211 Gdańsk, Poland; (M.R.-G.); (K.M.); (G.R.)
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Oiwa M, Kuroda K, Kawanoue N, Morimatsu H. Histidine-rich glycoprotein as a novel predictive biomarker of postoperative complications in intensive care unit patients: a prospective observational study. BMC Anesthesiol 2022; 22:232. [PMID: 35858852 PMCID: PMC9296898 DOI: 10.1186/s12871-022-01774-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2022] [Accepted: 07/12/2022] [Indexed: 11/30/2022] Open
Abstract
Background Decrease in histidine-rich glycoprotein (HRG) was reported as a cause of dysregulation of the coagulation-fibrinolysis and immune systems, leading to multi-organ failure, and it may be a biomarker for sepsis, ventilator-associated pneumonia, preeclampsia, and coronavirus disease 2019. However, the usefulness of HRG in perioperative management remains unclear. This study aimed to assess the usefulness of HRG as a biomarker for predicting postoperative complications. Methods This was a single-center, prospective, observational study of 150 adult patients who were admitted to the intensive care unit after surgery. Postoperative complications were defined as those having a grade II or higher in the Clavien–Dindo classification, occurring within 7 days after surgery. The primary outcome was HRG levels in the patients with and without postoperative complications. The secondary outcome was the ability of HRG, white blood cell, C-reactive protein, procalcitonin, and presepsin to predict postoperative complications. Data are presented as number and median (interquartile range). Results The incidence of postoperative complications was 40%. The HRG levels on postoperative day 1 were significantly lower in patients who developed postoperative complications (n = 60; 21.50 [18.12–25.74] µg/mL) than in those who did not develop postoperative complications (n = 90; 25.46 [21.05–31.63] µg/mL). The Harrell C-index scores for postoperative complications were HRG, 0.65; white blood cell, 0.50; C-reactive protein, 0.59; procalcitonin, 0.73; and presepsin, 0.73. HRG was independent predictor of postoperative complications when adjusted for age, the presence of preoperative cardiovascular comorbidities, American Society of Anesthesiologists Physical Status Classification, operative time, and the volume of intraoperative bleeding (adjusted hazard ratio = 0.94; 95% confidence interval, 0.90–0.99). Conclusions The HRG levels on postoperative day 1 could predict postoperative complications. Hence, HRG may be a useful biomarker for predicting postoperative complications. Supplementary Information The online version contains supplementary material available at 10.1186/s12871-022-01774-7.
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Affiliation(s)
- Masahiko Oiwa
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan.
| | - Kosuke Kuroda
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Naoya Kawanoue
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
| | - Hiroshi Morimatsu
- Department of Anesthesiology and Resuscitology, Okayama University Graduate School of Medicine, Dentistry and Pharmaceutical Sciences, 2-5-1, Shikata-cho, Kita-ku, Okayama, 700-8558, Japan
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12
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Gaudino M, Di Franco A, Rong LQ, Cao D, Pivato CA, Soletti GJ, Chadow D, Cancelli G, Perezgrovas Olaria R, Gillinov M, DiMaio JM, Girardi LN. Pericardial Effusion Provoking Atrial Fibrillation After Cardiac Surgery: JACC Review Topic of the Week. J Am Coll Cardiol 2022; 79:2529-2539. [PMID: 35738715 DOI: 10.1016/j.jacc.2022.04.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/04/2022] [Accepted: 04/18/2022] [Indexed: 11/18/2022]
Abstract
Postoperative atrial fibrillation (POAF) is the most common complication after cardiac surgery. Patients who develop POAF are more likely to experience adverse outcomes, including increased rates of death, stroke, heart failure, and hospitalizations, and higher hospital costs. Understanding the mechanisms underlying POAF is important to improve patients' outcome and optimize health systems' efficiency. Beyond classic pathogenic hypotheses, emerging evidence suggests that postoperative pericardial effusion and localized pericardial inflammation may trigger POAF. This hypothesis is supported by data from nonhuman animal models and a growing body of evidence showing that reducing postoperative pericardial effusion might reduce POAF incidence. In this review, we summarize the classic pathophysiology theories of POAF following cardiac surgery and discuss new etiologic mechanisms with a specific focus on the role of pericardial effusion and inflammation.
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Affiliation(s)
- Mario Gaudino
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA.
| | - Antonino Di Franco
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Lisa Q Rong
- Department of Anesthesiology, Weill Cornell Medicine, New York, New York, USA
| | - Davide Cao
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Cardiovascular Department, Humanitas Gavazzeni, Bergamo, Italy
| | - Carlo A Pivato
- The Zena and Michael A. Wiener Cardiovascular Institute, Icahn School of Medicine at Mount Sinai, New York, New York, USA; Department of Biomedical Sciences, Humanitas University, Pieve Emanuele-Milan, Italy; IRCCS Humanitas Research Hospital, Rozzano, Milan, Italy
| | - Giovanni J Soletti
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - David Chadow
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | - Gianmarco Cancelli
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
| | | | - Marc Gillinov
- Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio, USA
| | - J Michael DiMaio
- Department of Cardiothoracic Surgery, Baylor Scott & White Heart Hospital, Plano, Texas, USA
| | - Leonard N Girardi
- Department of Cardiothoracic Surgery, Weill Cornell Medicine, New York, New York, USA
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13
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Abstract
Atrial fibrillation occurs in 5-40% patients after coronary artery bypass graft surgery. Atrial fibrillation increases mortality and morbidity in the post-operative period. We sought to conduct a comprehensive review of literature focusing on pathophysiology, risk factors, prevention and treatment of post coronary artery bypass graft atrial fibrillation.
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Affiliation(s)
- Ashraf Mostafa
- Department of Internal Medicine, Wayne State University School of Medicine, Detroit, MI, USA
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14
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Nso N, Bookani KR, Metzl M, Radparvar F. Role of inflammation in atrial fibrillation: A comprehensive review of current knowledge. J Arrhythm 2021; 37:1-10. [PMID: 33664879 PMCID: PMC7896450 DOI: 10.1002/joa3.12473] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/24/2020] [Accepted: 11/14/2020] [Indexed: 11/11/2022] Open
Abstract
BACKGROUND Atrial fibrillation (AF) is one of the most common cardiac disorders affecting adults and is associated with significant morbidity and mortality. Efforts to manage AF through anti-arrhythmics and rate control have been largely unsatisfactory. It has become clear that AF causes structural alterations in the atrial myocardium that propagate further AF, and that some of these alterations are the result of inflammation. METHODS An in-depth review of the available literature was undertaken using Google Scholar and keyword searches including [Atrial fibrillation] in combination with [inflammatory markers], [myocardial fibrosis], and [immunomodulators], limiting the search to English language articles. All articles were reviewed for relevance and collated by the author. RESULTS Multiple markers of inflammation have been shown to be elevated in AF and to predict responses to treatments of AF including anti-arrhythmics and cardioversion. The nidus of inflammation is not clear but seems to be related to the pulmonary veins. CONCLUSIONS The inflammatory cascade induces fibrotic changes in the myocardium, an arrhythmogenic process that stimulates further inflammation. Advances in treatment are focusing on biological agents and immunomodulators that inhibit the inflammatory cascade.
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Affiliation(s)
- Nso Nso
- Department of Internal MedicineDivision of CardiologyIcahn School of Medicine at Mount Sinai/Queens (Queens Hospital Center)JamaicaNYUSA
| | - Kaveh R. Bookani
- Department of MedicineDivision of Cardiovascular Medicine (Northshore Program)University of ChicagoEvanstonILUSA
| | - Mark Metzl
- Department of MedicineDivision of Cardiovascular Medicine (Northshore Program)University of ChicagoEvanstonILUSA
| | - Farshid Radparvar
- Department of Internal MedicineDivision of CardiologyIcahn School of Medicine at Mount Sinai/Queens (Queens Hospital Center)JamaicaNYUSA
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15
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Sathnur N, Li JM, Krishnappa D, G Benditt D. Impact of Denervation by Heart Transplantation on Post-operative Atrial Fibrillation Susceptibility. J Atr Fibrillation 2020; 13:2397. [PMID: 33024498 DOI: 10.4022/jafib.2397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2020] [Revised: 02/13/2020] [Accepted: 03/17/2020] [Indexed: 11/10/2022]
Abstract
Atrial fibrillation is common following cardiac and non-cardiac thoracic surgery and is associated with poorer outcomes, including: increased risk of stroke, hemodynamic instability, prolonged hospital stay, and increased mortality. Current understanding suggests that post-op atrial fibrillation results from the interplay of local and systemic operative inflammation, increased sympathetic activity, perhaps the release of free radical species in the perioperative period, and the patient's underlying cardiac substrate. Cardiac denervation following orthotopic heart transplant (OHT) using modern bicaval techniques presents a unique opportunity to study the relative contribution of the autonomic nervous system to post-op atrial fibrillation susceptibility. Observational studies show a reduced incidence of post-operative atrial fibrillation following orthotopic heart transplant compared to other cardiac and thoracic surgeries. Moreover, comparison of atrial fibrillation rates with double lung transplant recipients suggests that cardiac denervation has a contribution apart from surgical pulmonary vein isolation alone. This report reviews current concepts of the mechanisms of post-op atrial fibrillation with a focus on the role of the autonomic nervous system, the autonomic regulation of the native heart, and evidence regarding the impact of cardiac denervation following OHT.
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Affiliation(s)
- Neeraj Sathnur
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine
| | - Jian-Ming Li
- Division of Cardiology, VA Medical Center, University of Minnesota, Minneapolis, Minnesota
| | - Darshan Krishnappa
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine
| | - David G Benditt
- Cardiac Arrhythmia Center, Cardiovascular Division, Department of Medicine
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16
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Simbaqueba CC, Aponte MP, Kim P, Deswal A, Palaskas NL, Iliescu C, Jahangir E, Yang EH, Steiner RE, Lopez-Mattei J. Cardiovascular Complications of Chimeric Antigen Receptor T-Cell Therapy: The Cytokine Release Syndrome and Associated Arrhythmias. ACTA ACUST UNITED AC 2020; 3:113-120. [DOI: 10.36401/jipo-20-10] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2020] [Accepted: 05/28/2020] [Indexed: 12/19/2022]
Abstract
ABSTRACT
In recent years, cancer treatment has evolved, and new therapies have been introduced with significant improvement in prognosis. The immunotherapies stand out owing to their efficacy and remission rate. Chimeric antigen receptor (CAR) T-cell therapy is a part of this new era of therapies. Chimeric antigen receptor T-cell therapy is a form of adoptive cellular therapy that uses a genetically encoded CAR in modified human T cells to target specific tumor antigens in a nonconventional, non-major histocompatibility complex (MHC) protein presentation. Chimeric antigen receptor T-cell therapy successfully identifies tumor antigens and through activation of T cells destroys tumoral cells. It has been found to efficiently induce remission in patients who have been previously treated for B-cell malignancies and have persistent disease. As the use of this novel therapy increases, its potential side effects also have become more evident, including major complications like cytokine release syndrome (CRS) and immune effector cell-associated neurotoxicity syndrome (ICANS). Cytokine release syndrome is a major systemic inflammatory process as a result of massive cytokine production by the proliferating and activated CAR T cells in which multiple interleukins and immune cells contribute to the inflammatory response. Cytokine release syndrome has been associated with cardiovascular life-threatening complications including hypotension, shock, tachycardia, arrhythmias, left ventricular dysfunction, heart failure, and cardiovascular death. Arrhythmias, among its major complications, vary from asymptomatic prolonged corrected QT interval (QTc) to supraventricular tachycardia, atrial fibrillation, flutter, and ventricular arrhythmias like Torsade de pointes. This article focuses on the cardiovascular complications and arrhythmias associated with CRS and CAR T-cell therapy.
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Affiliation(s)
- Cesar Clavijo Simbaqueba
- Department of General Internal Medicine, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Maria Patarroyo Aponte
- Department of Cardiology, University of Texas Health System, Memorial Hermann Hospital, Houston, Texas
| | - Peter Kim
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Anita Deswal
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Nicolas L. Palaskas
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Cezar Iliescu
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Eiman Jahangir
- Department of Cardiology, Vanderbilt University Medical Center, Vanderbilt, Tennessee
| | - Eric H. Yang
- UCLA Cardio-Oncology Program, Division of Cardiology, Department of Medicine, University of California at Los Angeles, Los Angeles, California
| | - Raphael E. Steiner
- Department of Lymphoma-Myeloma, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Juan Lopez-Mattei
- Department of Cardiology, University of Texas MD Anderson Cancer Center, Houston, Texas
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17
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Fujii Y. Evaluation of Inflammation Caused by Cardiopulmonary Bypass in a Small Animal Model. BIOLOGY 2020; 9:biology9040081. [PMID: 32326072 PMCID: PMC7236599 DOI: 10.3390/biology9040081] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/17/2020] [Revised: 04/16/2020] [Accepted: 04/17/2020] [Indexed: 01/20/2023]
Abstract
Extracorporeal circulation (ECC) methods are being increasingly used for mechanical support of respiratory and cardio-circulatory failure. Especially, cardiopulmonary bypass (CPB) during cardiovascular surgery, sustenance of the patient’s life by providing an appropriate blood flow and oxygen supply to principal organs. On the other hand, systemic inflammatory responses in patients undergoing cardiovascular surgery supported by CPB contribute significantly to CPB-associated mortality and morbidity. Our previous research showed that CPB causes a systemic inflammatory response and organ damage in a small animal CPB model. We have been studying the effects of hyperoxia and blood plasma substitute on CPB. In this review, we present a study focusing on the systemic inflammatory response during CPB, along with our findings.
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Affiliation(s)
- Yutaka Fujii
- Department of Clinical Engineering and Medical Technology, Niigata University of Health and Welfare, Niigata 950-3198, Japan
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18
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Maimari M, Baikoussis NG, Gaitanakis S, Dalipi-Triantafillou A, Katsaros A, Kantsos C, Lozos V, Triantafillou K. Does minimal invasive cardiac surgery reduce the incidence of post-operative atrial fibrillation? Ann Card Anaesth 2020; 23:7-13. [PMID: 31929240 PMCID: PMC7034196 DOI: 10.4103/aca.aca_158_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Atrial fibrillation (AF) is the most common post-operative complication and tends to be the most common arrhythmia after cardiac surgery. The etiology and risk factors for post-operative AF are poorly understood, but older age, large left atrium, diffuse coronary artery disease, a history of AF paroxysms and in general, pre-existing cardiac conditions that cause restricting and susceptibility towards inflammation have been consistently linked with post-operative atrial fibrillation (POAF). It has been traditionally thought that post-operative AF is transient, well-tolerated, benign to the patient and self-limiting complication of cardiac surgery that was temporary and easily treated. However, recent evidence suggests that POAF may be more "malignant" than previously thought, associated with follow-up mortality and morbidity. Several minimally invasive approaches, including the right parasternal approach, upper and lower mini-sternotomy (MS), V-shaped, Z-shaped, inverse-T, J-, reverse-C and reverse-L partial MS, transverse sternotomy and right mini-thoracotomy, have been developed for cardiac surgery operations since 1993 and have been associated with better outcomes and lower perioperative morbidity compared to full sternotomy (FS). The common goal of several minimally invasive approaches is to reduce invasiveness and surgical trauma. According to a statement from the American Heart Association (AHA), the term "minimally invasive" refers to a small chest wall incision that does not include a FS. This review is aimed to evaluate the use of minimally invasive techniques like mini-sternotomy, mini-thoracotomy and hybrid techniques versus conventional techniques which are used in cardiac surgery and to compare the frequency of post-operative AF and its effect on post-operative complications, morbidity and mortality, after cardiac surgery operations with FS versus cardiac surgery operations with the use of minimally invasive techniques.
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Affiliation(s)
- Maria Maimari
- Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
| | - Nikolaos G Baikoussis
- Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
| | - Stelios Gaitanakis
- Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
| | | | - Andreas Katsaros
- Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
| | - Charilaos Kantsos
- Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
| | - Vasileios Lozos
- Department of Cardiac Surgery, Ippokrateio General Hospital of Athens, Athens, Greece
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20
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Chou DT, Hong D, Oksuz S, Schweizer R, Roy A, Lee B, Shridhar P, Gorantla V, Kumta PN. Corrosion and bone healing of Mg-Y-Zn-Zr-Ca alloy implants: Comparative in vivo study in a non-immobilized rat femoral fracture model. J Biomater Appl 2019; 33:1178-1194. [PMID: 30732513 DOI: 10.1177/0885328219825568] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Biodegradable magnesium (Mg) alloys exhibit improved mechanical properties compared to degradable polymers while degrading in vivo circumventing the complications of permanent metals, obviating the need for surgical removal. This study investigated the safety and efficacy of Mg-Y-Zn-Zr-Ca (WZ42) alloy compared to non-degradable Ti6Al4V over a 14-week follow-up implanted as pins to fix a full osteotomy in rat femurs and as wires wrapped around the outside of the femurs as a cerclage. We used a fully load bearing model allowing implants to intentionally experience realistic loads without immobilization. To assess systemic toxicity, blood cell count and serum biochemical tests were performed. Livers and kidneys were harvested to observe any accumulation of alloying elements. Hard and soft tissues adjacent to the fracture site were also histologically examined. Degradation behavior and bone morphology were determined using micro-computed tomography scans. Corrosion occurred gradually, with degradation seen after two weeks of implantation with points of high stress observed near the fracture site ultimately resulting in WZ42 alloy pin fracture. At 14 weeks however, normal bone healing was observed in femurs fixed with the WZ42 alloy confirmed by the presence of osteoid, osteoblast activity, and new bone formation. Blood testing exhibited no significant changes arising from the WZ42 alloy compared to the two control groups. No recognizable differences in the morphology and more importantly, no accumulation of Mg, Zn, and Ca in the kidney and liver of rats were observed. These load bearing model results collectively taken, thus demonstrate the feasibility for use of the Mg-Y-Zn-Zr-Ca alloy for long bone fracture fixation applications.
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Affiliation(s)
- Da-Tren Chou
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Daeho Hong
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Sinan Oksuz
- 2 Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Riccardo Schweizer
- 2 Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA
| | - Abhijit Roy
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Boeun Lee
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Puneeth Shridhar
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Vijay Gorantla
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA
| | - Prashant N Kumta
- 1 Department of Bioengineering, University of Pittsburgh, Pittsburgh, PA, USA.,2 Department of Mechanical Engineering and Materials Science, University of Pittsburgh, Pittsburgh, PA, USA.,3 Department of Chemical and Petroleum Engineering, University of Pittsburgh, Pittsburgh, PA, USA.,4 Center for Craniofacial Regeneration, University of Pittsburgh, Pittsburgh, PA, USA.,5 Center for Complex Engineered Multifunctional Materials, University of Pittsburgh, PA, USA
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21
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González-Montero J, Brito R, Gajardo AIJ, Rodrigo R. Myocardial reperfusion injury and oxidative stress: Therapeutic opportunities. World J Cardiol 2018; 10:74-86. [PMID: 30344955 PMCID: PMC6189069 DOI: 10.4330/wjc.v10.i9.74] [Citation(s) in RCA: 111] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Revised: 04/27/2018] [Accepted: 05/10/2018] [Indexed: 02/06/2023] Open
Abstract
Acute myocardial infarction (AMI) is the leading cause of death worldwide. Its associated mortality, morbidity and complications have significantly decreased with the development of interventional cardiology and percutaneous coronary angioplasty (PCA) treatment, which quickly and effectively restore the blood flow to the area previously subjected to ischemia. Paradoxically, the restoration of blood flow to the ischemic zone leads to a massive production of reactive oxygen species (ROS) which generate rapid and severe damage to biomolecules, generating a phenomenon called myocardial reperfusion injury (MRI). In the clinical setting, MRI is associated with multiple complications such as lethal reperfusion, no-reflow, myocardial stunning, and reperfusion arrhythmias. Despite significant advances in the understanding of the mechanisms accounting for the myocardial ischemia reperfusion injury, it remains an unsolved problem. Although promising results have been obtained in experimental studies (mainly in animal models), these benefits have not been translated into clinical settings. Thus, clinical trials have failed to find benefits from any therapy to prevent MRI. There is major evidence with respect to the contribution of oxidative stress to MRI in cardiovascular diseases. The lack of consistency between basic studies and clinical trials is not solely based on the diversity inherent in epidemiology but is also a result of the methodological weaknesses of some studies. It is quite possible that pharmacological issues, such as doses, active ingredients, bioavailability, routes of administration, co-therapies, startup time of the drug intervention, and its continuity may also have some responsibility for the lack of consistency between different studies. Furthermore, the administration of high ascorbate doses prior to reperfusion appears to be a safe and rational therapy against the development of oxidative damage associated with myocardial reperfusion. In addition, the association with N-acetylcysteine (a glutathione donor) and deferoxamine (an iron chelator) could improve the antioxidant cardioprotection by ascorbate, making it even more effective in preventing myocardial reperfusion damage associated with PCA following AMI.
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Affiliation(s)
- Jaime González-Montero
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 70058, Chile
| | - Roberto Brito
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 70058, Chile
- Internal Medicine Department, University of Chile, Clinical Hospital, Santiago 70058, Chile
| | - Abraham IJ Gajardo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 70058, Chile
- Internal Medicine Department, University of Chile, Clinical Hospital, Santiago 70058, Chile
| | - Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of Chile, Santiago 70058, Chile
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22
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Máca J, Peteja M, Reimer P, Jor O, Šeděnková V, Panáčková L, Ihnát P, Burda M, Ševčík P. Surgical injury: comparing open surgery and laparoscopy by markers of tissue damage. Ther Clin Risk Manag 2018; 14:999-1006. [PMID: 29881282 PMCID: PMC5985784 DOI: 10.2147/tcrm.s153359] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
Background Major abdominal surgery (MAS) is high-risk intervention usually accompanied by tissue injury leading to a release of signaling danger molecules called alarmins. This study evaluates the surgical injury caused by two fundamental types of gastrointestinal surgical procedures (open surgery and laparoscopy) in relation to the inflammation elicited by alarmins. Patients and methods Patients undergoing MAS were divided into a mixed laparoscopy group (LPS) and an open surgery group (LPT). Serum levels of alarmins (S100A8, S100A12, HMGB1, and HSP70) and biomarkers (leukocytes, C-reactive protein [CRP], and interleukin-6 [IL-6]) were analyzed between the groups. The secondary objectives were to compare LPT and LPS cancer subgroups and to find the relationship between procedure and outcome (intensive care unit length of stay [ICU-LOS] and hospital length of stay [H-LOS]). Results A total of 82 patients were analyzed. No significant difference was found in alarmin levels between the mixed LPS and LPT groups. IL-6 was higher in the LPS group on day 2 (p=0.03) and day 3 (p=0.04). Significantly higher S100A8 protein levels on day 1 (p=0.02) and day 2 (p=0.01) and higher S100A12 protein levels on day 2 (p=0.03) were obtained in the LPS cancer subgroup. ICU-LOS and H-LOS were longer in the LPS cancer subgroup. Conclusion The degree of surgical injury elicited by open MAS as reflected by alarmins is similar to that of laparoscopic procedures. Nevertheless, an early biomarker of inflammation (IL-6) was higher in the laparoscopy group, suggesting a greater inflammatory response. Moreover, the levels of S100A8 and S100A12 were higher with a longer ICU-LOS and H-LOS in the LPS cancer subgroup.
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Affiliation(s)
- Jan Máca
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Matúš Peteja
- The Clinic of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Petr Reimer
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Ondřej Jor
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Věra Šeděnková
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Lucie Panáčková
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
| | - Peter Ihnát
- The Clinic of Surgery, University Hospital Ostrava, Ostrava, Czech Republic
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava, Czech Republic
| | - Pavel Ševčík
- Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava, Czech Republic
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Maca J, Holub M, Bursa F, Ihnat P, Reimer P, Svagera Z, Burda M, Sevcik P. Alarmins as biomarkers of gastrointestinal surgical injury - a pilot study. APMIS 2018; 126:152-159. [PMID: 29700911 DOI: 10.1111/apm.12798] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2017] [Accepted: 11/12/2017] [Indexed: 12/21/2022]
Abstract
The dysregulation of inflammatory response to surgical injury affects outcomes. Alarmins, the earliest bioactive substances from damaged cells, play a crucial role in initiating the inflammation. We analyzed serum levels of alarmins (S100A8, S100A12, high mobility group box, and heat shock protein 70) after major abdominal surgery (MAS) in surgical (S) (n = 82) and nonsurgical (NS) groups (n = 35). The main objective was determining a role of selected alarmins in host response to MAS. The secondary objectives were (i) evaluation of the relationship among alarmins and selected biomarkers (C-reactive protein, interleukin-6), (ii) influence of the place of gastrointestinal resection, and (iii) role of alarmins in MAS for cancer. Except for HMGB1, the levels of all alarmins were higher in the S group compared with the NS group. In the S group, positive correlations were found between S100A8 and both IL-6 and CRP. Additionally, the S100A8 level was higher (p < 0.01) in patients who underwent upper gastrointestinal tract (GIT) surgery compared to middle and lower GIT resections. Alarmins levels did not differ between cancer and noncancer patients. MAS is able to elicit increase in alarmin levels. S100A8 can be considered a potential biomarker of surgical injury, especially in the upper part of the GIT.
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Affiliation(s)
- Jan Maca
- Faculty of Medicine, Department of Intensive Care Medicine and Forensic Studies, University of Ostrava, Ostrava-Poruba, Czech Republic.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic.,First Faculty of Medicine, Department of Infectious Diseases, Charles University in Prague and Military University Hospital, Prague, Czech Republic
| | - Michal Holub
- First Faculty of Medicine, Department of Infectious Diseases, Charles University in Prague and Military University Hospital, Prague, Czech Republic
| | - Filip Bursa
- Faculty of Medicine, Department of Intensive Care Medicine and Forensic Studies, University of Ostrava, Ostrava-Poruba, Czech Republic.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Peter Ihnat
- Department of Surgery, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Petr Reimer
- Faculty of Medicine, Department of Intensive Care Medicine and Forensic Studies, University of Ostrava, Ostrava-Poruba, Czech Republic.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Zdenek Svagera
- Institute of Laboratory Diagnostics, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
| | - Michal Burda
- Institute for Research and Applications of Fuzzy Modeling, Centre of Excellence IT4Innovations, University of Ostrava, Ostrava-Poruba, Czech Republic
| | - Pavel Sevcik
- Faculty of Medicine, Department of Intensive Care Medicine and Forensic Studies, University of Ostrava, Ostrava-Poruba, Czech Republic.,Department of Anesthesiology and Intensive Care Medicine, University Hospital Ostrava, Ostrava-Poruba, Czech Republic
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Inflammation and the risk of atrial high-rate episodes (AHREs) in patients with cardiac implantable electronic devices. Clin Res Cardiol 2018; 107:772-777. [PMID: 29667016 PMCID: PMC6105258 DOI: 10.1007/s00392-018-1244-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Accepted: 04/09/2018] [Indexed: 12/03/2022]
Abstract
Introduction Atrial high-rate episodes (AHREs) are associated with an increased risk of developing atrial fibrillation and thromboembolism. The characteristics of ‘real world’ patients developing AHREs are poorly known. Methods We included 496 consecutive patients with cardiac implantable electronic devices (CIEDs). Primary endpoint was occurrence of AHREs, defined as > 175 bpm and lasting > 5 min, in a median follow-up of 16.5 (IQR 3.9–38.6) months (1082.4 patient-years). We also tested the predictive value of clinical risk scores for AHREs. Results Mean age was 68.8 ± 14.0 years, and 35.5% were women; AHREs were recorded in 173 patients [34.7%, 16.0%/year, 95% confidence interval (CI) 13.7–18.6]. Multivariable Cox regression analysis showed that age [hazard ratio (HR) 1.020, 95% CI 1.004–1.035, p = 0.011], prior AF (HR 3.521, 95% CI 2.831–5.206, p < 0.001), white cell count (HR 1.039, 95% CI 1.007–1.072, p = 0.016) and high C reactive protein (CRP; HR 1.039, 95% CI 1.021–2.056, p = 0.038) were independently associated with AHREs. ROC curve analysis showed that the APPLE score (C statistic 0.53, 95% CI 0.48–0.59; p = 0.296) ALARMEc score (C statistic 0.51, 95% CI 0.44–0.57; p = 0.810) were non-significantly associated with AHRE. Similar results were obtained for CHADS2 and CHA2DS2VASc score Conclusion AHREs are common in CIEDs patients, with age, prior AF, inflammatory markers (high CRP, white cell count) being factors associated with AHREs onset. Clinical risk scores showed limited value for AHREs prediction in this cohort. Electronic supplementary material The online version of this article (10.1007/s00392-018-1244-0) contains supplementary material, which is available to authorized users.
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25
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Abstract
New-onset atrial fibrillation (NOAF) is the most common perioperative complication of heart surgery, typically occurring in the perioperative period. NOAF commonly occurs in patients who are elderly, or have left atrial enlargement, or left ventricular hypertrophy. Various factors have been identified as being involved in the development of NOAF, and numerous approaches have been proposed for its prevention and treatment. Risk factors include diabetes, obesity, and metabolic syndrome. For prevention of NOAF, β-blockers and amiodarone are particularly effective and are recommended by guidelines. NOAF can be treated by rhythm/rate control, and antithrombotic therapy. Treatment is required in patients with decreased cardiac function, a heart rate exceeding 130 beats/min, or persistent NOAF lasting for ≥ 48 h. It is anticipated that anticoagulant therapies, as well as hemodynamic management, will also play a major role in the management of NOAF. When using warfarin as an anticoagulant, its dose should be adjusted based on PT-INR. PT-INR should be controlled between 2.0 and 3.0 in patients aged < 70 years and between 1.6 and 2.6 in those aged ≥ 70 years. Rate control combined with antithrombotic therapies for NOAF is expected to contribute to further advances in treatment and improvement of survival.
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Affiliation(s)
- Takeshi Omae
- Department of Anesthesiology and Pain Clinic, Juntendo University Shizuoka Hospital, 1129 Nagaoka, Izunokuni, Shizuoka, 410-2295, Japan. .,Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan.
| | - Eiichi Inada
- Department of Anesthesiology and Pain Medicine, School of Medicine, Juntendo University, Tokyo, Japan
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26
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Leite JO, Costa LO, Fonseca WM, Souza DU, Goncalves BC, Gomes GB, Cruz LA, Nister N, Navarro TP, Bath J, Dardik A. General outcomes and risk factors for minor and major amputations in Brazil. Vascular 2017; 26:291-300. [PMID: 29041830 DOI: 10.1177/1708538117736677] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objectives Major and minor amputations are associated with significant rates of mortality. However, little is known about the impact of unplanned redo-amputation during the same hospitalization on outcomes. The objectives of this study were to identify the risk factors associated with in-hospital mortality after both major and minor amputations as well as the results of unplanned redo-amputation on outcome. Methods Retrospective study of 342 consecutive patients who were treated with lower extremity amputation in Brazil between January 2013 and October 2014. Results The in-hospital mortality rate was higher in major compared to minor amputation (25.6% vs. 4.1%; p < 0.0001). Whereas chronic kidney disease, chronic obstructive pulmonary disease, and planned staged amputation predicted in-hospital mortality after major amputation, age, and congestive heart failure predicted mortality after minor amputation. The white blood cell count predicted in-hospital mortality following both major and minor amputation. However, postoperative infection predicted in-hospital mortality only following major amputation. Conclusions In-hospital mortality was high after major amputations. Unplanned redo-amputation was not a predictor of in-hospital mortality after major or minor amputation. Planned staged amputation was associated with reduced survival after major but not minor amputation. Postoperative infection predicted mortality after major amputation. Systemic diseases and postoperative white blood cell were associated with in-hospital mortality. This study suggests a possible link between a pro-inflammatory state and increased in-hospital mortality following amputation.
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Affiliation(s)
- Jose O Leite
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Leandro O Costa
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Walter M Fonseca
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Debora U Souza
- 2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil.,3 Faculdade de Fisioterapia, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil
| | - Barbara C Goncalves
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Gabriela B Gomes
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Lucas A Cruz
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Nilder Nister
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Tulio P Navarro
- 1 Faculdade de Medicina, Universidade Federal de Minas Gerais, Belo Horizonte, Brazil.,2 Departamento de Cirurgia Vascular, Hospital Risoleta Tolentino Neves, Belo Horizonte, Brazil
| | - Jonathan Bath
- 4 Department of Surgery, Division of Vascular Surgery, University of Cincinnati College of Medicine, Cincinnati, USA
| | - Alan Dardik
- 5 Department of Surgery, Division of Vascular Surgery, Yale School of Medicine, Yale University, New Haven, USA
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Risk factors for delirium after cardiac surgery: a historical cohort study outlining the influence of cardiopulmonary bypass. Can J Anaesth 2017; 64:1129-1137. [PMID: 28718100 DOI: 10.1007/s12630-017-0938-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2017] [Revised: 06/17/2017] [Accepted: 07/06/2017] [Indexed: 12/29/2022] Open
Abstract
PURPOSE Cardiopulmonary bypass (CPB) induces a significant inflammatory response that may increase the risk for delirium. We hypothesized that exposure to CPB during coronary artery bypass grafting (CABG) surgery would correlate with an increased risk of delirium. METHODS We reviewed clinical data from two databases at our medical centre - the Cardiac Surgery Perioperative Outcomes Database and the Society of Thoracic Surgeons Database. Patients undergoing elective CABG surgery (on-pump and off-pump) from November 1, 2009 to September 30, 2015 were included in the study. Delirium was defined as any postoperative positive Confusion Assessment Method for the Intensive Care Unit exam during the intensive care unit stay. We performed logistic regression to isolate the association between CPB exposure and delirium adjusted for predetermined risk factors and potential confounders. RESULTS During the study period, 2,280 patients underwent elective CABG surgery, with 384 patients (16.9%) exposed to CPB. Delirium was diagnosed in 451 patients (19.8%). Exposure to CPB showed a significant independent association with delirium. Patients exposed to CPB for 142 min (90th percentile of CPB duration) vs those exposed for 54 min (10th percentile) had an adjusted relative risk (RR) of delirium of 2.18 (95% confidence interval [CI], 1.39 to 3.07; P = 0.002) vs a RR of 1.51 (95% CI, 0.92 to 2.29; P = 0.10), respectively. CONCLUSIONS The use and duration of cardiopulmonary bypass were associated with an increased risk of delirium in patients undergoing CABG surgery. TRIAL REGISTRATION www.clinicaltrials.gov , NCT02548975. Registered 4 September 2015.
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Bockeria OL, Shvartz VA, Akhobekov AA, Glushko LA, Le TG, Kiselev AR, Prokhorov MD, Bockeria LA. Statin therapy in the prevention of atrial fibrillation in the early postoperative period after coronary artery bypass grafting: A meta-analysis. COR ET VASA 2017. [DOI: 10.1016/j.crvasa.2016.11.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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Ensor CR, Sabo RT, Voils SA. Impact of Early Postoperative Hydrocortisone Administration in Cardiac Surgical Patients after Cardiopulmonary Bypass. Ann Pharmacother 2017; 45:189-94. [DOI: 10.1345/aph.1p468] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND: The usefulness of glucocorticoids after cardiac surgery with cardiopulmonary bypass has been a matter of debate for many years. Exposure to cardiopulmonary bypass evokes the systemic inflammatory response syndrome in patients undergoing cardiac surgery. Intravenous glucocorticoids have been used to reduce proinflammatory cytokine release, slow leukocyte migration, and decrease capillary leak associated with cardiopulmonary bypass. OBJECTIVE: To assess the impact of early postoperative hydrocortisone administration on duration of vasoactive medication administration and the incidence of postoperative atrial fibrillation in cardiac surgical patients after cardiopulmonary bypass. METHODS: A retrospective cohort study (between July 1, 2004, and June 30, 2008) was conducted at a large, university-affiliated, tertiary-care medical center. One-hundred forty-seven patients who underwent cardiac surgery with cardiopulmonary bypass, 72 of whom received at least 1 dose of hydrocortisone (treatment), and 75 similar patients who did not receive hydrocortisone (control), were randomly selected. RESULTS: Cardiopulmonary bypass and aortic cross-clamp times were similar between treatment and control groups (128 vs 124 minutes, p = 0.56; 103 vs 98 minutes, p = 0.39). Patients who received hydrocortisone had a significantly shorter time to discontinuation of all vasoactive medications (79.6 vs 21.1 hours, p < 0.001), and less postoperative atrial fibrillation (OR 0.28, 95% CI 0.14 to 0.56, p < 0.001). Patients in the treatment group experienced significantly more hyperglycemia (89 vs 71%, p = 0.006); however, major and minor bleeding or infection rates did not differ significantly between groups. CONCLUSIONS: Patients treated with hydrocortisone after cardiac surgery with cardiopulmonary bypass experienced a significantly shorter time to discontinuation of all vasoactive medications and less postoperative atrial fibrillation than patients not treated with hydrocortisone. These benefits came at the expense of significantly more hyperglycemia.
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White blood cell count and new-onset atrial fibrillation after cardiac surgery. Int J Cardiol 2017; 228:971-976. [DOI: 10.1016/j.ijcard.2016.11.038] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2016] [Revised: 08/20/2016] [Accepted: 11/05/2016] [Indexed: 11/21/2022]
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Baker WL, White CM. Cardiology: Post-Cardiothoracic Surgery Atrial Fibrillation: A Review of Preventive Strategies. Ann Pharmacother 2016; 41:587-98. [PMID: 17374620 DOI: 10.1345/aph.1h594] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Objective: To review the available literature addressing preventive strategies of post-cardiothoracic surgery atrial fibrillation (post-CTS atrial fibrillation). Data Sources: Pertinent articles related to the etiology, risk factors, and preventive strategies were identified through a MEDLINE search (1966–March 2007) using the MeSH terms atrial fibrillation, cardiothoracic surgery, cardiac surgery, etiology, neurohormonal, sympathetic, volume, fluid, inflammation, risk factors, operative, pacing, β-adrenergic blockers, amiodarone, sotalol, calcium-channel blockers, magnesium, HMG-CoA reductase inhibitors, statins, fatty acids, PUFA, steroids, and nonsteroidal antiinflammatory drugs. Study Selection and Data Extraction: Articles evaluated were limited to human studies, published in the English language, with a Jadad score greater than 3. References of identified articles were reviewed for additional pertinent articles. Data Synthesis: Post-CTS atrial fibrillation most commonly occurs on the second or third postoperative day, with an incidence of 20–50%. Etiology theories include neurohormonal activation, volume overload, and inflammation. Studies examining nonpharmacologic therapies have shown that maintenance of the anterior epicardial fat pad is not a viable prophylactic strategy. Biatrial cardiac pacing, especially in combination with amiodarone, is a viable preventive option. Withdrawal of preoperative β-blockers places patients at higher risk for atrial fibrillation; these drugs should be continued postoperatively. Evidence exists supporting the use of amiodarone, sotalol, and magnesium in addition to β-blockers. Since most of these strategies work by attenuating neurohormonal activation, adverse events, including hypotension and bradycardia, are of concern. Adding agents with antiinflammatory properties, including hydroxymethylglutaryl coenzyme A reductase inhibitors or corticosteroids, may prove to be of benefit. Additional studies using novel therapies are needed in addition to established preventive strategies. Conclusions: Available evidence supports the continuation of preoperative β-blockers, as well as prophylactic amiodarone, sotalol, and magnesium. Other novel therapies, mostly targeting inflammation, are under investigation and may provide additional strategies.
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Affiliation(s)
- William L Baker
- School of Pharmacy, University of Connecticut, Hartford, CT, USA
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ABDEL-SALAM ZAINAB, NAMMAS WAIL. Atrial Fibrillation After Coronary Artery Bypass Surgery: Can Ivabradine Reduce Its Occurrence? J Cardiovasc Electrophysiol 2016; 27:670-6. [DOI: 10.1111/jce.12974] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/10/2016] [Revised: 02/29/2016] [Accepted: 03/15/2016] [Indexed: 01/21/2023]
Affiliation(s)
- ZAINAB ABDEL-SALAM
- Cardiology Department, Faculty of Medicine; Ain Shams University; Cairo Egypt
| | - WAIL NAMMAS
- Cardiology Department, Faculty of Medicine; Ain Shams University; Cairo Egypt
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Bockeria OL, Shvartz VA, Akhobekov AA, Kiselev AR, Prokhorov MD, Golukhova EZ, Bockeria LA. Statin therapy in the primary prevention of early atrial fibrillation after coronary artery bypass grafting. Indian Heart J 2016; 68:792-797. [PMID: 27931549 PMCID: PMC5143807 DOI: 10.1016/j.ihj.2016.04.002] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2016] [Revised: 03/22/2016] [Accepted: 04/01/2016] [Indexed: 01/25/2023] Open
Abstract
OBJECTIVE Assessment of the role of statin therapy in the prevention of postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) in patients without prior atrial fibrillation. METHODS A retrospective analysis of 206 patients, aged 57.2±7.9 years (mean±SD), who underwent isolated CABG is carried out. All patients are divided into two groups. The first group (nSt-patients) includes the patients who did not receive statin therapy prior to CABG (n=82). The second group (St-patients) includes the patients who received statin therapy prior to CABG (n=124). Both groups received the statin therapy from the first day after CABG. The risk of occurrence of POAF is evaluated using the Cox-regression model. RESULTS The rate of POAF was 25.6% in nSt-patients and 6.5% in St-patients (P=0.020). On the 4th day after CABG, white blood cells (WBC) count was 11.0 (9.0, 13.0)×109/mL (medians with inter-quartile ranges) in nSt-patients and 9.0 (7.6, 10.2)×109/mL in St-patients (P<0.001). The peak WBC numbers occurred on the day of POAF onset. The Cox-regression analysis shows that only two factors (statin therapy and number of grafts) had significant influence on the POAF onset. Odds ratio of POAF event prediction by statin therapy was 0.20 (95%CI: 0.08-0.51), P<0.001. Each subsequent graft increased the risk of POAF in 2.1 times. CONCLUSION Statin therapy carried out prior to the CABG is an effective approach to primary prevention of POAF in early postoperative period. Statin therapy after CABG in nSt-patients does not give prophylactic effect observed in St-patients.
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Affiliation(s)
- O L Bockeria
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia.
| | - V A Shvartz
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - A A Akhobekov
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - A R Kiselev
- Department of Surgical Treatment for Interactive Pathology, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia.
| | - M D Prokhorov
- Saratov Branch of the Institute of Radio Engineering and Electronics of Russian Academy of Sciences, Saratov, Russia
| | - E Z Golukhova
- Nonivasive Arrhythmology Department, Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
| | - L A Bockeria
- Bakoulev Scientific Center for Cardiovascular Surgery, Moscow, Russia
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Abstract
Cardiopulmonary bypass (CPB) is indispensable for cardiac surgery but leads to systemic inflammatory responses and leukocyte activation, possibly due to blood contact with the surface of the CPB unit, surgical, ischemic reperfusion injury, etc. Systemic inflammatory responses during CPB result in increased morbidity and mortality. Activation of leukocytes is an important part of this process and directly contributes to coagulopathy and hemorrhage. This inflammatory response may contribute to the development of postoperative complications, including myocardial dysfunction, respiratory failure, renal and neurologic dysfunction, altered liver function and ultimately, multiple organ failure. Various pharmacologic and mechanical strategies have been developed to minimize the systemic inflammatory response during CPB. For example, leukocyte removal filters were developed in the 1990s for incorporation into the CPB circuit. However, studies of this approach have yielded conflicting findings. The purpose of this was to review the studies of a novel leukocyte removal filter in patients undergoing CPB.
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Affiliation(s)
- Yutaka Fujii
- a Department of Artificial Organs , National Cerebral and Cardiovascular Center Research Institute , Osaka , Japan
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Association of White Blood Cell Count and Differential with the Incidence of Atrial Fibrillation: The Atherosclerosis Risk in Communities (ARIC) Study. PLoS One 2015; 10:e0136219. [PMID: 26313365 PMCID: PMC4551739 DOI: 10.1371/journal.pone.0136219] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/03/2015] [Accepted: 07/31/2015] [Indexed: 01/03/2023] Open
Abstract
Background Although inflammation is involved in the development of atrial fibrillation (AF), the association of white blood cell (WBC) count and differential with AF has not been thoroughly examined in large cohorts with extended follow-up. Methods We studied 14,500 men and women (25% blacks, 55% women, mean age 54) free of AF at baseline (1987–89) from the Atherosclerosis Risk in Communities (ARIC) study, a community-based cohort in the United States. Incident AF cases through 2010 were identified from study electrocardiograms, hospital discharge records and death certificates. Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HR) and 95% confidence intervals (CI) for AF associated with WBC count and differential. Results Over a median follow-up time of 21.5 years for the entire cohort, 1928 participants had incident AF. Higher total WBC count was associated with higher AF risk independent of AF risk factors and potential confounders (HR 1.09, 95% CI 1.04–1.15 per 1-standard deviation [SD] increase). Higher neutrophil and monocyte counts were positively associated with AF risk, while an inverse association was identified between lymphocyte count and AF (multivariable adjusted HRs 1.16, 95% CI 1.09–1.23; 1.05, 95% CI 1.00–1.11; 0.91, 95% CI 0.86–0.97 per 1-SD, respectively). No significant association was identified between eosinophils or basophils and AF. Conclusions High total WBC, neutrophil, and monocyte counts were each associated with higher AF risk while lymphocyte count was inversely associated with AF risk. Systemic inflammation may underlie this association and requires further investigation for strategies to prevent AF.
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Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015; 154:13-20. [PMID: 26116810 DOI: 10.1016/j.pharmthera.2015.06.009] [Citation(s) in RCA: 141] [Impact Index Per Article: 15.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2015] [Accepted: 06/18/2015] [Indexed: 01/24/2023]
Abstract
Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that occurs in up to 60% of patients. POAF is associated with increased risk of cardiovascular mortality, stroke and other arrhythmias that can impact on early and long term clinical outcomes and health economics. Many factors such as disease-induced cardiac remodelling, operative trauma, changes in atrial pressure and chemical stimulation and reflex sympathetic/parasympathetic activation have been implicated in the development of POAF. There is mounting evidence to support a major role for inflammation and oxidative stress in the pathogenesis of POAF. Both are consequences of using cardiopulmonary bypass and reperfusion following ischaemic cardioplegic arrest. Subsequently, several anti-inflammatory and antioxidant drugs have been tested in an attempt to reduce the incidence of POAF. However, prevention remains suboptimal and thus far none of the tested drugs has provided sufficient efficacy to be widely introduced in clinical practice. A better understanding of the cellular and molecular mechanisms responsible for the onset and persistence of POAF is needed to develop more effective prediction and interventions.
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Affiliation(s)
- M Zakkar
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - R Ascione
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - A F James
- School of Physiology & Pharmacology, University of Bristol, Medical Sciences Building, University Walk, Bristol, BS8 1TD, UK
| | - G D Angelini
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK
| | - M S Suleiman
- Bristol Heart Institute, University of Bristol, Level 7, Bristol Royal Infirmary, Upper Maudlin Street, Bristol BS2 8HW, UK.
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Weimann K, Zimmermann M, Spies CD, Wernecke KD, Vicherek O, Nachtigall I, Tafelski S, Weimann A. Intensive Care Infection Score--A new approach to distinguish between infectious and noninfectious processes in intensive care and medicosurgical patients. J Int Med Res 2015; 43:435-51. [PMID: 25850686 DOI: 10.1177/0300060514557711] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2014] [Accepted: 10/03/2014] [Indexed: 01/01/2023] Open
Abstract
OBJECTIVES Clinicians regularly encounter substantial time delays in diagnosing sepsis and administering appropriate antibiotic treatment. This study investigated the ability of the Intensive Care Infection Score (ICIS) to distinguish between infectious and noninfectious processes, and to assess the justified commencement of antibiotic therapy retrospectively, in line with hospital actual best practice and applied laboratory parameters. METHODS Intensive-care unit (ICU) patients were enrolled in this retrospective, observational study. Clinical data and laboratory parameters were determined daily. The cohort was divided into infected and noninfected patient groups. RESULTS Out of 172 ICU patients, including 72 postoperative patients, the predictive value for infection throughout the first 5 days in 'all patients' and the 'postoperative patient' group was highest for ICIS. An ICIS cut-off value of three could predict infection in postoperative patients with 82.9% sensitivity and 75.1% specificity. ICIS showed the lowest rate of potentially 'falsely encouraged' and 'discouraged' antibiotic therapies for noninfected and for septic postoperative patients, respectively, compared with C-reactive protein, procalcitonin and white blood cell levels. CONCLUSIONS In the ICU, particularly for postoperative patients, ICIS is a reliable marker for the timely identification of infection. ICIS may qualify as a new decision support tool for antibiotic therapy, when interpreted within the clinical context.
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Affiliation(s)
- Karin Weimann
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Mathias Zimmermann
- Department of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany Labor Berlin - Charité Vivantes Services, Berlin, Germany
| | - Claudia D Spies
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | | | - Oldrich Vicherek
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Irit Nachtigall
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Sascha Tafelski
- Department of Anaesthesiology and Intensive Care Medicine, Campus Virchow-Klinikum and Campus Charité Mitte, University Medical Centre, Berlin, Germany
| | - Andreas Weimann
- Department of Laboratory Medicine, Clinical Chemistry and Pathobiochemistry, Charité Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany Labor Berlin - Charité Vivantes Services, Berlin, Germany
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Arakawa M, Miyata H, Uchida N, Motomura N, Katayama A, Tamura K, Sueda T, Takamoto S. Postoperative Atrial Fibrillation After Thoracic Aortic Surgery. Ann Thorac Surg 2015; 99:103-8. [DOI: 10.1016/j.athoracsur.2014.08.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/04/2013] [Revised: 07/24/2014] [Accepted: 08/06/2014] [Indexed: 11/17/2022]
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Dehghani MR, Kasianzadeh M, Rezaei Y, Sepehrvand N. Atorvastatin Reduces the Incidence of Postoperative Atrial Fibrillation in Statin-Naive Patients Undergoing Isolated Heart Valve Surgery: A Double-Blind, Placebo-Controlled Randomized Trial. J Cardiovasc Pharmacol Ther 2014; 20:465-72. [PMID: 25540059 DOI: 10.1177/1074248414564869] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/20/2014] [Accepted: 11/21/2014] [Indexed: 12/16/2022]
Abstract
BACKGROUND Atorvastatin has been demonstrated to reduce the incidence of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery, but its effect on isolated heart valve surgery is unknown. METHODS In a randomized, double-blinded, placebo-controlled trial, 58 patients who underwent isolated heart valve surgery supported by on-pump cardiopulmonary bypass were randomly assigned to receive either placebo (n = 29) or 40 mg of atorvastatin once daily starting 3 days preoperatively and continuing within 5 days postoperatively (n = 29). A continuous monitoring tool and an electrocardiographic Holter monitoring were used for detecting the POAF (Clinical Trial Registration: www.clinicaltrials.gov; Unique Identifier: NTC02084069). RESULTS The patients' median age was 49 years, and 67% were female. In all, 6 (21%) and 13 (45%) cases of POAF were observed in the atorvastatin and placebo groups, respectively (P = .050). The duration of AF before re-establishment of sinus rhythm was significantly lower in the atorvastatin group than in the placebo group (median of 70 vs 132 minutes, P = .026). The lengths of intensive care unit and hospital stay were comparable between the groups. The increase in postoperative white blood cell count was significantly lower in the atorvastatin group than in the placebo group (median of 1.5 vs 2.3 × 10(3)/µL, respectively, P = .019). After adjustment, the atorvastatin treatment was associated with a decrease in the risk of developing POAF (odds ratio 0.122, 95% confidence interval 0.027-0.548, P = .006). CONCLUSION Perioperative treatment with 40 mg of atorvastatin is useful to decrease the incidence of POAF in the statin-naive patients undergoing isolated heart valve surgery.
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Affiliation(s)
- Mohammad Reza Dehghani
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Majid Kasianzadeh
- Department of Cardiology, Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Yousef Rezaei
- Seyyed-al-Shohada Heart Center, Urmia University of Medical Sciences, Urmia, Iran
| | - Nariman Sepehrvand
- Department of Medicine, Canadian VIGOUR Centre, University of Alberta, Edmonton, Alberta, Canada
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Lewek J, Kaczmarek K, Cygankiewicz I, Wranicz JK, Ptaszynski P. Inflammation and arrhythmias: potential mechanisms and clinical implications. Expert Rev Cardiovasc Ther 2014; 12:1077-85. [DOI: 10.1586/14779072.2014.942286] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Narducci ML, Pelargonio G, Rio T, Leo M, Di Monaco A, Musaico F, Pazzano V, Trotta F, Liuzzo G, Severino A, Biasucci LM, Scapigliati A, Glieca F, Cavaliere F, Rebuzzi AG, Massetti M, Crea F. Predictors of Postoperative Atrial Fibrillation in Patients With Coronary Artery Disease Undergoing Cardiopulmonary Bypass: A Possible Role for Myocardial Ischemia and Atrial Inflammation. J Cardiothorac Vasc Anesth 2014; 28:512-9. [DOI: 10.1053/j.jvca.2013.06.002] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Indexed: 11/11/2022]
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Jacob KA, Nathoe HM, Dieleman JM, van Osch D, Kluin J, van Dijk D. Inflammation in new-onset atrial fibrillation after cardiac surgery: a systematic review. Eur J Clin Invest 2014; 44:402-28. [PMID: 24387767 DOI: 10.1111/eci.12237] [Citation(s) in RCA: 71] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/22/2013] [Accepted: 12/26/2013] [Indexed: 12/22/2022]
Abstract
BACKGROUND Postoperative new-onset atrial fibrillation (PNAF) is the most common complication following cardiac surgery. The pathogenesis of PNAF is multifactorial. The concept of the postoperative inflammatory response, as a potential underlying mechanism has been extensively studied. This review aims to provide a comprehensive summary of literature relevant to the association between the inflammatory response following cardiac surgery and PNAF. DESIGN MEDLINE, EMBASE and the Cochrane Central Register were systematically reviewed by two independent investigators for studies published between January 1980 and May 2012, in which an association between serum markers of inflammation and PNAF was evaluated, or the effect of drugs with anti-inflammatory properties on the risk of PNAF. RESULTS Sixty-three studies met selection criteria (39 observational and 24 randomized studies) including 27,363 patients. The mean incidence of PNAF after cardiac surgery was 25·5%. Elevated levels of various inflammatory mediators were associated with PNAF, and the most consistent association was found between white blood cell count and PNAF. Of the drugs with anti-inflammatory properties, statins gave the best protective effect against PNAF, followed by anti-oxidants, steroids and colchicine. Nonsteroidal anti-inflammatory drugs did not prevent PNAF significantly. CONCLUSION The postoperative inflammation response may play a role in the pathogenesis of PNAF. However, of the inflammation biomarkers, only elevated white blood cell count reliably predicts PNAF. Pre- and perioperative use of statins and several other drugs with anti-inflammatory properties reduce the incidence of PNAF.
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Affiliation(s)
- Kirolos A Jacob
- Department of Cardiothoracic Surgery, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Cardiology, University Medical Center Utrecht, Utrecht, the Netherlands; Department of Anesthesiology and Intensive Care, University Medical Center Utrecht, Utrecht, the Netherlands
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Friedrichs K, Adam M, Remane L, Mollenhauer M, Rudolph V, Rudolph TK, Andrié RP, Stöckigt F, Schrickel JW, Ravekes T, Deuschl F, Nickenig G, Willems S, Baldus S, Klinke A. Induction of atrial fibrillation by neutrophils critically depends on CD11b/CD18 integrins. PLoS One 2014; 9:e89307. [PMID: 24558493 PMCID: PMC3928425 DOI: 10.1371/journal.pone.0089307] [Citation(s) in RCA: 39] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/03/2013] [Accepted: 01/21/2014] [Indexed: 01/09/2023] Open
Abstract
Background Recent observational clinical and ex-vivo studies suggest that inflammation and in particular leukocyte activation predisposes to atrial fibrillation (AF). However, whether local binding and extravasation of leukocytes into atrial myocardium is an essential prerequisite for the initiation and propagation of AF remains elusive. Here we investigated the role of atrial CD11b/CD18 mediated infiltration of polymorphonuclear neutrophils (PMN) for the susceptibility to AF. Methods and Results C57bl/6J wildtype (WT) and CD11b/CD18 knock-out (CD11b−/−) mice were treated for 14 days with subcutaneous infusion of angiotensin II (Ang II), a known stimulus for PMN activation. Atria of Ang II-treated WT mice were characterized by increased PMN infiltration assessed in immunohistochemically stained sections. In contrast, atrial sections of CD11b−/− mice lacked a significant increase in PMN infiltration upon Ang II infusion. PMN infiltration was accompanied by profoundly enhanced atrial fibrosis in Ang II treated WT as compared to CD11b−/− mice. Upon in-vivo electrophysiological investigation, Ang II treatment significantly elevated the susceptibility for AF in WT mice if compared to vehicle treated animals given an increased number and increased duration of AF episodes. In contrast, animals deficient of CD11b/CD18 were entirely protected from AF induction. Likewise, epicardial activation mapping revealed decreased electrical conduction velocity in atria of Ang II treated WT mice, which was preserved in CD11b−/− mice. In addition, atrial PMN infiltration was enhanced in atrial appendage sections of patients with persistent AF as compared to patients without AF. Conclusions The current data critically link CD11b-integrin mediated atrial PMN infiltration to the formation of fibrosis, which promotes the initiation and propagation of AF. These findings not only reveal a mechanistic role of leukocytes in AF but also point towards a potential novel avenue of treatment in AF.
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Affiliation(s)
- Kai Friedrichs
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Matti Adam
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Lisa Remane
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Martin Mollenhauer
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Volker Rudolph
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Tanja K. Rudolph
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - René P. Andrié
- Department of Medicine-Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Florian Stöckigt
- Department of Medicine-Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Jan W. Schrickel
- Department of Medicine-Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Thorben Ravekes
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Florian Deuschl
- Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany
| | - Georg Nickenig
- Department of Medicine-Cardiology, University Hospital of Bonn, Bonn, Germany
| | - Stephan Willems
- Department of Electrophysiology, University Heart Center Hamburg, Hamburg, Germany
| | - Stephan Baldus
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
| | - Anna Klinke
- Heart Center, University of Cologne, Cologne, Germany
- Cologne Cardiovascular Research Center, University of Cologne, Cologne, Germany
- * E-mail:
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Ozaydin M, Peker O, Erdogan D, Akcay S, Yucel H, Icli A, Ceyhan BM, Sutcu R, Uysal BA, Varol E, Dogan A, Okutan H. Oxidative status, inflammation, and postoperative atrial fibrillation with metoprolol vs carvedilol or carvedilol plus N-acetyl cysteine treatment. Clin Cardiol 2014; 37:300-6. [PMID: 24477817 DOI: 10.1002/clc.22249] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/26/2013] [Revised: 12/12/2013] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND Atrial fibrillation is associated with inflammation and oxidative stress. HYPOTHESIS Carvedilol and N-acetyl cysteine (NAC) combination decreases inflammation, oxidative stress, and postoperative atrial fibrillation (POAF) rates more than metoprolol or carvedilol. METHODS Preoperative and postoperative total oxidative stress (TOS), total antioxidant capacity (TAC), and white blood cells (WBC) were measured in metoprolol, carvedilol, or carvedilol plus NAC groups, and association with POAF was evaluated. RESULTS Preoperative TAC, TOS, and WBC levels were similar among the groups. Postoperative TAC levels were lower in the metoprolol group compared with the carvedilol group (1.0 vs 1.4) or the carvedilol plus NAC group (1.0 vs 1.9) and were also lower in the carvedilol group compared with the carvedilol plus NAC group (all P < 0.0001). Postoperative TOS levels were higher in the metoprolol group as compared with the carvedilol (29.6 vs 24.2; P < 0.0001) or the carvedilol plus NAC groups (P < 0.0001), and were also higher in the carvedilol group as compared with the carvedilol plus NAC group (24.2 vs 19.3; P < 0.0001). Postoperative WBC counts were lower in the carvedilol plus NAC group compared with the metoprolol group (12.9 vs 14.8; P = 0.004), were similar between the carvedilol and the metoprolol groups (13 vs 14.8) and between the carvedilol plus NAC group and the carvedilol group (both P > 0.05). Postoperative TAC, TOS, and WBC were associated with POAF. CONCLUSIONS Carvedilol plus NAC reduced oxidative stress and inflammation compared with metoprolol and decreased oxidative stress compared with carvedilol. Postoperative TAC, TOS, and WBC were associated with POAF.
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Affiliation(s)
- Mehmet Ozaydin
- Department of Cardiology, Suleyman Demirel University, Isparta, Turkey
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Aburawi EH, Souid AK, Liuba P, Zoubeidi T, Pesonen E. Early changes in myocardial repolarization and coronary perfusion after cardiopulmonary bypass surgery for ASD repair in children. BMC Cardiovasc Disord 2013; 13:67. [PMID: 24015980 PMCID: PMC3846500 DOI: 10.1186/1471-2261-13-67] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2012] [Accepted: 09/03/2013] [Indexed: 11/25/2022] Open
Abstract
Background In adults, impaired myocardial repolarization and increased risk of arrhythmia are known consequences of open heart surgery. Little is known, however, about post-operative consequences of cardiopulmonary bypass surgery in children. The aim of this study was to assess ventricular repolarization and coronary perfusion after bypass surgery for atrial septal defect (ASD) repair in children. Methods Twelve patients with ASD were assessed one day before and 5–6 days after ASD repair. Myocardial repolarization (corrected QT interval, QTc, QT dispersion, QTd, and PQ interval) was determined on 12-lead electrocardiograms. Coronary flow in proximal left anterior descending artery (peak flow velocity in diastole, PFVd) was assessed by transthoracic Doppler echocardiography. Results Ten of the 12 (83%) children had normal myocardial repolarization before and after surgery. After surgery, QTc increased 1-9% in 5 (42%) patients, decreased 2-11% in 5 (42%) patients and did not change in 2 (16%) patients. Post-op QTc positively correlated with bypass time (R=0.686, p=0.014) and changes in PFVd (R=0.741, p=0.006). After surgery, QTd increased 33-67% in 4 (33%) patients, decreased 25-50% in 6 patients (50%) and did not change in 2 (16%) patients. After surgery, PQ interval increased 5-30% in 4 (33%) patients, decreased 4-29% in 6 (50%) patients and did not change in 1 (8%) patient. Post-op PQ positively correlated with bypass time (R=0.636, p=0.027). As previously reported, PFVd significantly increased after surgery (p<0.001). Conclusions Changes in QTc, PQ and PFVd are common in young children undergoing surgery for ASD repair. Post-op QTc significantly correlates with bypass time, suggesting prolonged cardiopulmonary bypass may impair ventricular repolarization. Post-op QTc significantly correlates with PFVd changes, suggesting increased coronary flow may also impair ventricular repolarization. The clinical significance and reversibility of these alternations require further investigations.
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Affiliation(s)
- Elhadi H Aburawi
- Pediatric Department, Section of Pediatric Cardiology, Skane University Hospital, Lund University, Lund, Sweden.
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Mirhosseini SJ, Ali-Hassan-Sayegh S, Forouzannia SK. What is the exact predictive role of preoperative white blood cell count for new-onset atrial fibrillation following open heart surgery? Saudi J Anaesth 2013; 7:40-2. [PMID: 23717231 PMCID: PMC3657923 DOI: 10.4103/1658-354x.109807] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Background: Atrial fibrillation (AF) occurs in 30% patients on the second or third day post operation; therefore, it is the most prevalent and complicated arrhythmia after open heart surgery. White blood cell (WBC) count seems to be most significantly associated with cardiovascular disorders. This study was designed to evaluate the exact relationship between preoperative WBC count and post-Coronary artery bypass graft (CABG) AF in patients with severe left ventricle (LV) dysfunction who underwent elective off-pump coronary artery bypass. Methods: This study was conducted on 104 patients from among 400 patients with severe LV dysfunction undergoing elective off-pump CABG surgery from February 2011 to February 2012, in Afshar Cardiovascular Center, Yazd, Iran. Patients with emergency surgery, unstable angina creatinine higher than 2.0 mg/dL, malignancy, or immunosuppressive disease were excluded. Preoperative serological tests of the participants, such as WBC counts, were saved in their medical dossiers. Of the 400 patients undergoing CABG, AF was found in 54 cases; these 54 male patients formed the experimental group and 60 other patients in the intensive care unit (ICU) and hospital stay without postoperative AF were part of the control group. Results: The average age of the patients was 68.5±12.8 years. WBC counts in patients with and without AF three days before surgery were 12,340±155 and 8,950±170, respectively. On surgical day, WBC counts in the patients with and without AF were 13,188±140 and 9,145±255, respectively (P value three days before surgery: 0.04; P value on surgical day: 0.01). Of the 54 male patients with postoperative AF (POAF), duration of AF was more in cases with elevated WBC count (12,000-14,000) than in those with lower elevated WBC count (10,000-12,000) (]P=0.025), but there was no relationship between frequency of recurrence of AF and grading of elevation of WBC count (]P=0.81). Conclusion: These findings show that three days before surgery and on surgery day, there was a difference in WBC count between both groups. So, preoperative WBC count may predict the incidence and duration of AF; however, it cannot be a predictor of the frequency of recurrence of AF. Finally, WBC count is an independent marker for POAF and duration of AF.
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Affiliation(s)
- Seyed Jalil Mirhosseini
- Department of Cardiovascular Surgery, Yazd Cardiovascular Researches Center, Afshar Hospital, Shahid Sadoughi University of Medical Sciences, Yazd, Iran
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Jakubová M, Mitro P, Stančák B, Sabol F, Kolesár A, Cisarik P, Nagy V. The occurrence of postoperative atrial fibrillation according to different surgical settings in cardiac surgery patients. Interact Cardiovasc Thorac Surg 2012; 15:1007-12. [PMID: 22927177 DOI: 10.1093/icvts/ivs361] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
OBJECTIVES Atrial fibrillation is the most common arrhythmia after cardiac surgery. The pathogenesis of postoperative atrial fibrillation is multifactorial. The aim of the study was to analyse preoperative, intraoperative and postoperative factors and their relationships with the occurrence and duration of atrial fibrillation. METHODS One hundred and ninety-six patients with coronary heart disease (152 men, age 62.7 ± 10.1 years) underwent surgical revascularization. Extracorporeal circulation was used in 64 patients and minimal extracorporeal circulation was used in 75 patients. Fifty-seven patients underwent surgery without extracorporeal circulation. During the first three postoperative days, subjects were monitored for the duration and incidence of atrial fibrillation, laboratory markers of inflammation (C-reactive protein, leucocytes) and serum potassium. RESULTS Demographic data and associated cardiovascular diseases in the groups were not statistically different. The overall incidence of atrial fibrillation was 56% (110 patients). The highest incidence of atrial fibrillation was found in the extracorporeal circulation subgroup, with a significantly lower incidence using minimal extracorporeal circulation, and in patients operated on without extracorporeal circulation (75 vs 47 vs 46%, P <0.001). The longest duration of atrial fibrillation was found in patients operated on with extracorporeal circulation compared with minimal extracorporeal circulation, and without extracorporeal circulation (9.7 ± 11.6 vs 4.9 ± 8.3 vs 3.1 ± 5.2, P ≤0.001). The incidence of postoperative atrial fibrillation significantly correlated with elevation of inflammatory markers (C-reactive protein, leucocytes) compared with patients who were free of atrial fibrillation (P ≤0.001, P ≤0.05). The values of serum potassium were not significantly different. The relationship between postoperative atrial fibrillation and echocardiographic parameters was not confirmed. CONCLUSIONS The use of extracorporeal circulation leads to a higher incidence of postoperative atrial fibrillation compared with the use of minimal extracorporeal circulation or with surgery without extracorporeal circulation, probably due to enhanced systemic inflammatory response.
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Affiliation(s)
- Marta Jakubová
- Clinic of Anesthesiology UPJŠ LF and VÚSCH, a.s., Košice, Slovakia.
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Friedrichs K, Baldus S, Klinke A. Fibrosis in Atrial Fibrillation - Role of Reactive Species and MPO. Front Physiol 2012; 3:214. [PMID: 22723783 PMCID: PMC3379725 DOI: 10.3389/fphys.2012.00214] [Citation(s) in RCA: 65] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2012] [Accepted: 05/30/2012] [Indexed: 12/19/2022] Open
Abstract
Atrial fibrosis with enhanced turnover and deposition of matrix proteins leads to inhomogeneous atrial electrical conduction and gives rise to electrical reentry circuits resulting in atrial fibrillation. The multifactorial pathogenesis of atrial fibrosis involves resident cardiac cells as well as infiltrating leukocytes, both generating and sequestering matrix metalloproteinases (MMPs), a key enzyme family involved in fibrosis. A growing body of evidence points toward an important role of reactive oxygen species (ROS) in the release and activation of pro-MMPs and the stimulation of pro-fibrotic cascades. Myeloperoxidase (MPO), a bactericidal enzyme released from activated polymorphonuclear neutrophils (PMN) is not only associated with a variety of cardiovascular diseases, but has also been shown to be mechanistically linked to atrial fibrosis and fibrillation. MPO catalyzes the generation of reactive species like hypochlorous acid, which affect intracellular signaling cascades in various cells and advance activation of pro-MMPs and deposition of atrial collagen resulting in atrial arrhythmias. Thus, inflammatory mechanisms effectively promote atrial structural remodeling and importantly contribute to the initiation and perpetuation of atrial fibrillation.
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Affiliation(s)
- Kai Friedrichs
- Department of Electrophysiology, Cardiovascular Research Center, University Heart Center Hamburg Hamburg, Germany
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Kawamura M, Munetsugu Y, Kawasaki S, Onishi K, Onuma Y, Kikuchi M, Tanno K, Kobayashi Y. Type III procollagen-N-peptide as a predictor of persistent atrial fibrillation recurrence after cardioversion. Europace 2012; 14:1719-25. [DOI: 10.1093/europace/eus162] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
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Rodrigo R. Prevention of postoperative atrial fibrillation: novel and safe strategy based on the modulation of the antioxidant system. Front Physiol 2012; 3:93. [PMID: 22518106 PMCID: PMC3325031 DOI: 10.3389/fphys.2012.00093] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2012] [Accepted: 03/26/2012] [Indexed: 01/15/2023] Open
Abstract
Postoperative atrial fibrillation (AF) is the most common arrhythmia following cardiac surgery with extracorporeal circulation. The pathogenesis of postoperative AF is multifactorial. Oxidative stress, caused by the unavoidable ischemia-reperfusion event occurring in this setting, is a major contributory factor. Reactive oxygen species (ROS)-derived effects could result in lipid peroxidation, protein carbonylation, or DNA oxidation of cardiac tissue, thus leading to functional and structural myocardial remodeling. The vulnerability of myocardial tissue to the oxidative challenge is also dependent on the activity of the antioxidant system. High ROS levels, overwhelming this system, should result in deleterious cellular effects, such as the induction of necrosis, apoptosis, or autophagy. Nevertheless, tissue exposure to low to moderate ROS levels could trigger a survival response with a trend to reinforce the antioxidant defense system. Administration of n-3 polyunsaturated fatty acids (PUFA), known to involve a moderate ROS production, is consistent with a diminished vulnerability to the development of postoperative AF. Accordingly, supplementation of n-3 PUFA successfully reduced the incidence of postoperative AF after coronary bypass grafting. This response is due to an up-regulation of antioxidant enzymes, as shown in experimental models. In turn, non-enzymatic antioxidant reinforcement through vitamin C administration prior to cardiac surgery has also reduced the postoperative AF incidence. Therefore, it should be expected that a mixed therapy result in an improvement of the cardioprotective effect by modulating both components of the antioxidant system. We present novel available evidence supporting the hypothesis of an effective prevention of postoperative AF including a two-step therapeutic strategy: n-3 PUFA followed by vitamin C supplementation to patients scheduled for cardiac surgery with extracorporeal circulation. The present study should encourage the design of clinical trials aimed to test the efficacy of this strategy to offer new therapeutic opportunities to patients challenged by ischemia-reperfusion events not solely in heart, but also in other organs such as kidney or liver in transplantation surgeries.
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Affiliation(s)
- Ramón Rodrigo
- Molecular and Clinical Pharmacology Program, Institute of Biomedical Sciences, Faculty of Medicine, University of ChileSantiago, Chile
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