RESUMEN
BACKGROUND: Atrial fibrillation (AF) is common after lung transplantation and can be challenging to manage. Objectives of this study were to determine prevalence and timing of perioperative AF, identify its risk factors, evaluate treatment strategies, assess return to sinus rhythm by hospital discharge, and investigate its impact on outcomes. METHODS: From March 1995 to January 2005, 333 patients underwent primary lung transplantation (exclusive of heart and lung transplantation). Data on timing, prevalence, management, and outcome were extracted from the Unified Transplant Registry and Cardiothoracic Anesthesia databases, supplemented with medical record review. Risk factors for AF were identified by logistic regression analysis, and bootstrap bagging was used for variable selection. RESULTS: AF developed postoperatively in 68 patients (20%), with the peak incidence 2 days after operation. Risk factors were older age (p = 0.0004), primary pulmonary hypertension (5 of 12 [42%] versus 63 of 321 [20%] for others, p = 0.006), and extremes of weight (p = 0.04). Pharmacologic treatment consisted of rate control agents only in 18 patients (27%), antiarrhythmics only in 5 (7.5%), and both in 44 (66%). Cardioversion was required in 24 (36%). Rhythm was recorded for 59 patients, and 55 (93%) were in sinus rhythm at discharge. Postoperative AF had no short-term or long-term survival impact. CONCLUSIONS: AF after lung transplantation is common, with occurrence peaking 2 days postoperatively. Older patients and those with primary pulmonary hypertension are at elevated risk. Treatment requires a combination of multiple pharmacologic agents and electrical cardioversion. Almost all patients are discharged in sinus rhythm, and prognosis is unaffected.
Asunto(s)
Fibrilación Atrial/etiología , Trasplante de Pulmón/efectos adversos , Complicaciones Posoperatorias/etiología , Adulto , Anciano , Antiarrítmicos/uso terapéutico , Fibrilación Atrial/epidemiología , Fibrilación Atrial/terapia , Índice de Masa Corporal , Cardioversión Eléctrica , Femenino , Humanos , Trasplante de Pulmón/mortalidad , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores de TiempoRESUMEN
OBJECTIVE: To compare outcomes and cost of off-pump coronary artery bypass (OP-CAB) surgery versus cardiopulmonary bypass-assisted coronary artery bypass graft (CABG) surgery. DESIGN: Retrospective review. SETTING: A tertiary care university teaching hospital. PARTICIPANTS: Patients (n = 300) undergoing isolated CABG surgery performed by a single surgeon between July 1998 and February 2000. INTERVENTIONS: Two groups of patients were compared: 150 consecutive patients undergoing OP-CAB surgery and a matched cohort of 150 consecutive patients undergoing conventional CABG surgery. MEASUREMENTS AND MAIN RESULTS: The 2 groups were evenly matched in terms of age and incidence of diabetes, hypertension, peripheral vascular disease, left main disease, prior strokes, congestive heart failure, and recent infarctions. OP-CAB procedures required 3.3 grafts per patient versus 3.8 grafts per patient required for CABG surgery (p = 0.02). Overall mortality was 2.0% (1.3% in the OP-CAB surgery group v 2.7 % in the CABG surgery group; p = NS). Extubation times (6.6 hours v 9.5 hours; p = 0.003), surgical intensive care unit length of stay (39 hours v 49 hours; p = 0.03), and hospital length of stay (6.1 days v 7.0 days; p = 0.04) were all significantly shorter for the OP-CAB surgery group. The combined aggregate endpoints of death and major morbidity were significantly less in the OP-CAB surgery group (5.3% v 12.7%; p = 0.02). CONCLUSION: OP-CAB surgery is associated with low morbidity and mortality and accelerated recovery compared with conventional CABG surgery. OP-CAB surgery may represent the ideal revascularization strategy for patients at high risk for undergoing cardiopulmonary bypass.