THE EFFECT OF CENTRAL VENOUS PRESSURE ON THE DEVELOPMENT OF ATRIAL FIBRILLATION AFTER CORONARY ARTERY BYPASS GRAFT OPERATION

Yıl 2022, , 69 - 74, 17.01.2022

Fehim Can Sevil , Mehmet Tort , Uğur Aksu , Necip Becit

https://doi.org/10.18229/kocatepetip.882650

Öz

OBJECTIVE: Arrhythmias that develop after cardiac operations may result in mortality and morbidity. Atrial fibrillation (AF) is one of the most common cardiac arrhythmias after coronary artery bypass grafting (CABG) operation. Central venous pressure (CVP) is a parameter related to the right atrial and right ventricular pressures. In our study, we aim/ed to investigate the effect of CVP elevation that may cause right atrial tension on the development of AF after CABG operation.
MATERIAL AND METHODS: Data of 278 patients who underwent CABG operation in our clinic between January 2010 and June 2020 were retrospectively analyzed. Patients who developed and did not develop AF after CABG operation were divided into two groups and their demographic characteristics, accompanying diseases, blood tests and mean CVP values in the first 24 hours after the operation were compared.
RESULTS: When the data obtained from 31 patients who developed AF after CABG operation and 247 patients who did not develop AF were compared, demographic characteristics of age (p = 0.091), gender (p = 0.595), height (p = 0.368) and weight (p=0.078) were found to be similar in the two groups. While accompanying risk factors and Euro scores were similar between the two groups, smoking was found to be significantly higher in the group without AF (p = 0.033). In blood tests, fibrinogen level (p = 0.013) and brain natriuretic peptide level (p = 0.037) were found to be significantly higher in the AF-developing group, while the thrombocyte count (p = 0.045) was found to be significantly higher in the group without AF. CVP values measured in the group developing AF after CABG operation were found to be significantly higher than the CVP values of the group without AF (p = 0.008).
CONCLUSIONS: It was observed that the high CVP value indicating the right atrial pressure after the CABG operation was effective in the development of AF. We think that CVP follow-up after CABG operation in the intensive care unit and keeping it at appropriate levels will reduce the possibility of AF that may develop.

Anahtar Kelimeler

Coronary, Atrial, Fibrillation, Central, Pressure

KORONER ARTER BAYPAS GREFTLEME OPERASYONU SONRASINDA ATRİYAL FİBRİLASYON GELİŞMESİNDE SANTRAL VENÖZ BASINCIN ETKİSİ

Öz

AMAÇ: Kardiyak operasyonlar sonrasında gelişen aritmiler mortalite ve morbidite ile sonuçlanabilir. Koroner arter baypas greftleme (KABG) operasyonu sonrasında atriyal fibrilasyon (AF) en sık görülen kardiyak aritmilerdendir. Santral venöz basınç (SVB) sağ atriyum ve sağ ventrikül basınçları ile ilişkili bir para-metredir. Çalışmamızda amacımız sağ atriyum gerginliğine ne-den olabilecek SVB yüksekliğinin KABG operasyonu sonrasında AF gelişmesi üzerine etkisinin araştırılmasıdır.
GEREÇ VE YÖNTEM: Ocak 2010 - Haziran 2020 yılları arasında kliniğimizde KABG operasyonu yapılan 278 hastanın verileri retrospektif olarak incelendi. KABG operasyonu sonrasında AF gelişen ve AF gelişmeyen hastalar iki gruba ayrıldı ve demografik özellikleri, eşlik eden hastalıkları, kan tetkikleri ve operasyon sonrası ilk 24 saatteki ortalama SVB değerleri karşılaştırıldı.
BULGULAR: KABG operasyonu sonrasında AF gelişen 31 hasta ile AF gelişmeyen 247 hastanın karşılaştırılmasında demografik özelliklerinden yaş (p=0,091), cinsiyet (p=0,595), boy (p=0,368) ve kilonun (p=0,078) iki grupta benzer olduğu görüldü. Eşlik eden risk faktörleri ve Euroskorları iki grup arasında benzer iken sigara kullanımının AF gelişmeyen grupta anlamlı olarak daha yüksek oranda olduğu saptandı (p=0,033). Kan tetkiklerinde fibrinojen seviyesi (p=0,013), brain natriüretik peptit seviyesi (p=0,037) AF gelişen grupta anlamlı olarak yüksek saptanırken trombosit sayısı (p=0,045) AF gelişmeyen grupta anlamlı olarak yüksek saptandı. KABG operasyonu sonrasında AF gelişen grupta ölçülen SVB değerleri AF gelişmeyen Grubun SVB değerlerinden anlamlı olarak yüksek saptandı (p=0,008).
SONUÇ: KABG operasyonu sonrasında sağ atriyum basıncını gösteren SVB değerinin yüksek saptanmasının AF gelişiminde etkili olduğu görüldü. Yoğun bakım ünitesinde KABG operasyonu sonrası SVB takibinin yapılması ve uygun seviyelerde tutulmasının gelişebilecek AF ihtimalini azaltacağı görüşündeyiz.

Anahtar Kelimeler

Koroner, Atriyal, Fibrilasyon, Santral, Basınç

Kaynakça

• 1. Bhatt HV, Fischer GW. Atrial Fibrillation: Pathophysiology and Therapeutic Options. Journal of Cardiothoracic and Vascular Anesthesia. 2015;29(5):1333-40.
• 2. Da Costa MAC, Lirani W, Wippich AC, et al. Comparison of two central venous pressure control strategies to prevent atrial fibrillation after coronary artery bypass grafting. Arq Bras Cardiol. 2017;108(4):297–03.
• 3. Schwann NM, Hillel Z, Hoeft A, et al. Lack of effectiveness of the pulmonary artery catheter in cardiac surgery. Anesth Analg. 2011;113(5):994-02.
• 4. Williams JB, Peterson ED, Wojdyla D, et al. Central venous pressure after coronary artery bypass surgery: Does it predict postoperative mortality or renal failure? J Crit Care. 2014;29(6):1006–10.
• 5. Buhre W, Weyland A, Schorn B, et al. Changes in central venous pressure and pulmonary capillary wedge pressure do not indicate changes in right and left heart volume in patients undergoing coronary artery bypass surgery. Eur J Anaesthesiol. 1999;16(1):11-7.
• 6. Echahidi N, Pibarot P, O’Hara G, Mathieu P. Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery. Journal of the American College of Cardiology. 2008;51(8):793-01.
• 7. Lomivorotov V V, Efremov SM, Pokushalov EA, Karaskov AM. New-Onset Atrial Fibrillation after Cardiac Surgery: Pathophysiology, Prophylaxis, and Treatment. Journal of Cardiothoracic and Vascular Anesthesia. 2016;30(1):200-16.
• 8. Tınelı RA, Sılva Junıor JRE, Lucıano PM, Rodrigues AJ, Vicente WVA, Evora PRB. Atrial fibrillation and cardiac surgery: a never ending and always controversial history. Braz J Cardiovasc Surg. 2005;20(3):323-31.
• 9. Bessissow A, Khan J, Devereaux PJ, Alvarez-Garcia J, Alonso-Coello P. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: An overview. Journal of Thrombosis and Haemostasis. 2015;13(11):2134.
• 10. Rader F, Van Wagoner DR, Ellinor PT, et al. Influence of race on atrial fibrillation after cardiac surgery. Circ Arrhythmia Electrophysiol. 2011;(4):644–52. 11. Zaman AG, Archbold RA, Helft G, Paul EA, Curzen NP, Mills PG. Atrial fibrillation after coronary artery bypass surgery: A model for preoperative risk stratification. Circulation. 2000;101(12):1403-8.
• 12. Mathew JP, Fontes ML, Tudor IC, et al. A Multicenter Risk Index for Atrial Fibrillation after Cardiac Surgery. J Am Med Assoc. 2004;291(14):1720-9.
• 13. Creswell LL, Schuessler RB, Rosenbloom M, Cox JL. Hazards of postoperative atrial arrhythmias. Ann Thorac Surg.1993;56(3):539-49.
• 14. Sevil FC. Management of endovascular treatment in spontaneous iliac artery dissections: Applications enabling classical surgery. Turkish J Thorac Cardiovasc Surg. 2020;28(4):601-8.
• 15. Kinoshita T, Asai T, Suzuki T, Kambara A, Matsubayashi K. Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardio- thoracic Surg. 2012;41(1):102–7.
• 16. Koch CG, Li L, Van Wagoner DR, Duncan AI, Gillinov AM, Blackstone EH. Red Cell Transfusion is Associated With an Increased Risk for Postoperative Atrial Fibrillation. Ann Thorac Surg. 2006;82(5):1747-56.
• 17. Conway DSG, Buggins P, Hughes E, Lip GYH. Relation of interleukin-6, C-reactive protein, and the prothrombotic state to transesophageal echocardiographic findings in atrial fibrillation. Am J Cardiol. 2004;93(11):1368-73.
• 18. Sbarouni E, Bradshaw A, Andreotti F, Tuddenham E, Oakley CM, Cleland JGF. Relationship between hemostatic abnormalities and neuroendocrine activity in heart failure. Am Heart J. 1994;127(3):607-12.
• 19. Kalus JS, Caron MF, White CM, Mather JF, Gallagher R, Boden WE, et al. Impact of fluid balance on incidence of atrial fibrillation after cardiothoracic surgery. Am J Cardiol. 2004;94(11):1423-5.
• 20. Raiten JM, Ghadimi K, Augoustides JGT, et al. Atrial fibrillation after cardiac surgery: Clinical update on mechanisms and prophylactic strategies. Journal of Cardiothoracic and Vascular Anesthesia. 2015;29(3):806-16.
• 21. Koletsis EN, Prokakis C, Crockett JR, et al. Prognostic factors of atrial fibrillation following elective coronary artery bypass grafting: The impact of quantified intraoperative myocardial ischemia. J Cardiothorac Surg. 2011;127(6).
• 22. Sanfilippo AJ, Abascal VM, Sheehan M, et al. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation.1990;82(3):792- 7.
• 23. Wang WH, Hsiao SH, Lin KL, Wu CJ, Kang PL, Chiou KR. Left atrial expansion index for predicting atrial fibrillation and in-hospital mortality after coronary artery bypass graft surgery. Ann Thorac Surg. 2012;93(3):796–03.
• 24. Farnsworth CW, Bailey AL, Jaffe AS, Scott MG. Diagnostic concordance between NT-proBNP and BNP for suspected heart failure. Clin Biochem. 2018; 59:50-55.
• 25. Tousoulis D, Papageorgiou N, Androulakis E, Briasoulis A, Antoniades C, Stefanadis C. Fibrinogen and cardiovascular disease: Genetics and biomarkers. Blood Rev. 2011;25(6):239-45.