Pre-operative use of anti-aggregants may reduce atrial fibrillation development rate during coronary bypass surgery

Abstract

Pre-operative use of anti-aggregants may reduce atrial fibrillation development rate during coronary bypass surgery Preoperatif antiagregan kullanımı koroner baypas cerrahisi süresince gelişebilecek atriyal fibrilasyon oranını azaltabilir Atrial fibrillation (AF) is one of the most common postoperative arrhythmias in patients who undergo coronary artery bypass grafting (1). This complication leads to increases in mortality and morbidity rate in coronary bypass surgery and in hospital stay caused by excess usage of medications (2). Diverse experimental and clinical trials are conducted to reduce post-operative AF development rate and associated complications; however, AF rate still remains to be up to 40% during bypass surgery. The etiology of postoperative AF is not well defined, although recent studies suggest a multi-factorial mechanism, which includes oxidative stress, inflammation, atrial fibrosis, and excessive production of catecholamines, changes in autonomic tone and in the expression of connexins (3, 4). By evaluating retrospectively our coronary bypass surgery results, we observed that we did not discontinue preoperatively used anti-aggregants since a long time and that postoperative AF rate was lower than found in coronary literature.At Dr. Siyami Ersek Cardiovascular and Thoracic Surgery Training and Research Hospital coronary artery bypass surgeries that are performed by the same clinic between January 2009 and December 2009 were reviewed retrospectively. Statistical analysis is made by SPSS 15. Stopping anti-aggregants therapy before coronary bypass surgery is a classical literature knowledge; therefore control group parameters are taken from the literature ratios. Atrial fibrillation development rate was retrospectively evaluated in 250 coronary bypass patients who used anti-aggregants and also not discontinued before the operation. There was no significant difference between selected patients in terms of clinical and laboratory examinations. There was no atrial fibrillation history in all patients. There was no significant difference in duration of operation and number of used graft. LIMA and saphenous vein were used as graft in all patients. Atrial diameter of patients was similar and they had no atrial dilatation. Atrial fibrillation was developed in 9 patients (3%). According to literature information (3, 4), atrial fibrillation rate was assessed very low.In the controls after two months; there was no statistically significant increase in AF ratio. There was no significant increase in postoperative administration of blood or blood derivative considered as side effects despite to continuation of anti-aggregant usage. Revision and tamponade rate due to bleeding was conforming to literature.Continuing to preoperative anti-aggregant in patients without AF development risk factors significantly reduces AF development rate and we conclude that this may be considered as our coronary experience of a wide serial. relation between blood and tissue magnesium levels and development of atrial fibrillation ...