Turk Kardiyol Dern Ars. 2014; 42(5): 419-425 | DOI: 10.5543/tkda.2014.84032
The effect of oxidative stress related with ischemia-reperfusion damage on the pathogenesis of atrial fibrillation developing after coronary artery bypass graft surgery
, Onur Baydar1
, Umit Yasar Sinan1
, Cuneyt Kocas1
, Okay Abaci1
, Ahmet Yildiz1
, Zerrin Yigit1
, Cenk Eray Yildiz2
, Alican Hatemi2
, Gurkan Cetin2
, Aysem Kaya31
Department of Cardiology, Cardiology Institute, İstanbul University, İstanbul2
Department of Cardiovascular Surgery, İstanbul University, Institute of Cardiology, İstanbul3
Department of Biochemistry, Istanbul University, Institute of Cardiology, Istanbul
OBJECTIVES We aimed to investigate the role of oxidative stress related with ischemia- reperfusion damage on the pathogenesis of atrial fibrillation (AF) developing after coronary artery bypass graft (CABG) surgery.
STUDY DESIGN In our prospective, single-center study, 118 patients who underwent elective isolated on-pump CABG surgery were included. Patients were divided into two groups according to the development of postoperative atrial fibrillation (POAF) as Group 1: Patients who developed POAF, and Group 2: Patients who remained in sinus rhythm. In addition to preoperative demographic, laboratory, echocardiographic, intraoperative, and postoperative clinical characteristics, levels of plasma total oxidative status (TOS) after placement and removal of aortic cross clamp (ACC) were compared between the two groups. Predictors of POAF were also investigated by multivariate logistic regression analysis.
RESULTS A comparison of preoperative demographic, laboratory, echocardiographic, and postoperative clinical characteristics between the two groups showed that patients in Group 1 were significantly older (65.6±7.20 vs. 59.6±9.07, p<0.001), had a lower hematocrit level (37.5±5.16 vs. 39.7±5.28; p=0.034), and an enlarged left atrium diameter (39±0.45 vs. 3.6±0.48; p=0.006). Changes in plasma TOS levels after placement and removal of ACC were statistically significant in Group 1 [13 (8.6- 23), 30 (18.1-47.3); p=0.001 vs. 14 (8.8-22.2), 24 (21.4-42.7); p=0.060]. Length of stay in the intensive care unit [3 (2-14) vs. 2 (1-58); p=0.001] and length of stay in hospital [7 (6-85) vs. 7 (5-58); p=0.001] were prolonged in Group 1. In multivariate logistic regression analysis, aging (odds ratio (OR): 1.088, 95% confidence interval (CI): 1.005-1.177; p=0.036), hematocrit level (OR: 0.718, 95% CI: 0.538-0.958; p=0.025), pump temperature (OR: 1.445, 95% CI: 1.059-1.972; p=0.020), and plasma TOS level (OR: 1.040, 95% CI: 1.020-1.050; p=0.040) were found to be independent predictors of POAF.
CONCLUSION Ischemia-reperfusion damage related with ACC placement may be an important factor on the pathogenesis of POAF. Minimizing the oxidative stress occurring intraoperatively should be targeted for preventing mortality and morbidity due to POAF
Atrial fibrillation/etiology/prevention & control, coronary artery bypass; coronary artery disease/surgery; oxidative stress.
How to cite this article
Veysel Oktay, Onur Baydar, Umit Yasar Sinan, Cuneyt Kocas, Okay Abaci, Ahmet Yildiz, Zerrin Yigit, Cenk Eray Yildiz, Alican Hatemi, Gurkan Cetin, Aysem Kaya. The effect of oxidative stress related with ischemia-reperfusion damage on the pathogenesis of atrial fibrillation developing after coronary artery bypass graft surgery. Turk Kardiyol Dern Ars. 2014; 42(5): 419-425
Corresponding Author: Veysel Oktay, Türkiye