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Atrial arrhythmias after pulmonary thromboendarterectomy
Author(s) -
Farasat Sadaf,
Papamatheakis Demosthenes G.,
Poch David S.,
Higgins Jill,
Pretorius Victor G.,
Madani Michael M.,
Auger William R.,
Kerr Kim M.,
Fernandes Timothy M.
Publication year - 2019
Publication title -
journal of cardiac surgery
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.428
H-Index - 58
eISSN - 1540-8191
pISSN - 0886-0440
DOI - 10.1111/jocs.14028
Subject(s) - medicine , pulmonary thromboendarterectomy , atrial fibrillation , odds ratio , cardiology , intensive care unit , confidence interval , pulmonary artery , logistic regression , demographics , concomitant , surgery , chronic thromboembolic pulmonary hypertension , demography , sociology
Background and Objectives Atrial arrhythmias (AAs) are common after cardiac surgeries including pulmonary thromboendarterectomy (PTE). This study was done to identify patients at highest risk of developing post‐PTE AA and their length of stay (LOS). Methods We reviewed 521 consecutive patients referred to University of California San Diego (UCSD) for PTE and examined their demographics as well as their baseline pulmonary hemodynamics to determine risk factors for AA. Results Overall, 24.2% of patients developed an AA after PTE. Patients who developed AA had a significantly longer Intensive Care Unit (ICU) LOS (median: 5 vs 3 days, P < 0.001) and postoperative LOS (median: 14 vs 9 days; P < 0.001). Patients who developed AA were more frequently male (63.2% male, P = 0.003), older (mean age 60.8 vs 50.7 years, P < 0.001), had a prior history of atrial fibrillation (80.2% of those who developed AA) and were more likely to have undergone concomitant Coronary Artery Bypass Graft (12.7% vs 6.6%, P = 0.028). Compared to those who did not develop AA, the cardiopulmonary bypass time was longer among those who developed AA (261.6 vs 253.8 minutes, P = 0.027). In a multivariate logistic regression model, the preoperative variables that predicted AA were age (odds ratio [OR], 1.058 per year, 95% confidence interval [CI]: 1.038‐1.078), male sex (OR, 1.68, 95% CI: 1.06‐2.64), prior AA (OR, 2.52, 95% CI: 1.23‐5.15) and baseline right atrial pressure (OR, 1.039 per mm Hg, 95% CI: 1.000‐1.079). While mortality rates were similar, patients who developed AA had more bleeding complications and more postoperative delirium. Conclusions AA is common after PTE surgery. The strongest risk factors for AA after PTE included the previous history of AA, age and male sex. Development of AA was associated with longer lengths of stay and more postoperative complications.