Does Off-pump Coronary Artery Bypass Reduce the Prevalence ofAtrial Fibrillation?

INTRODUCTION: To examine whether or not off-pump CABG (Coronary Artery Bypass Reduce) reduces the incidence of AF after cardiac surgery. METHODS: The study was carried out in 939 consecutive coronary artery disease patients with sinus rhythm from which 383 patients underwent off-pump CABG, and 556 patients were operated through on-pump CABG. All patients were monitored postoperatively during intensive care unit (ICU) stay. Then, the incidence and predictive risk factors of post operative AF (POAF) in two groups were determined and compared with each other. RESULTS: Overall, the mean age of the patients was 56.0±12.8 years with 234 patients (24.9%) being older than 65 years. POAF developed in 38 patients (9.9%) of the off-pump and in 93 patients (16.7%) of the on-pump CABG. There was significant difference between two groups when considering the incidence of POAF (P=0.002). Among preoperative risk factors, age>65 years had a significant association with the incidence of AF in both groups. This study also showed that most of the POAF cases converted to sinus rhythm after treatment. Moreover, these finding demonstrated that conversion to sinus rhythm is significantly more probable in off-pump group (P=0.006). CONCLUSION: A reduced prevalence of POAF could be observed in patients with off-pump as compared with on-pump techniques. Furthermore, conversion to sinus rhythm in off-pump group was significantly more probable than on-pump group.

Postoperative Atrial Fibrillation following Open Cardiac Surgery: Predisposing Factors and Complications.

INTRODUCTION: New-onset postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery that has substantial effects on outcomes. The aim of this study is to analyze the risk factors in the pre, intra, and postoperative periods, and evaluate its impact on patients' outcome. METHODS: In this prospective study, between March 2007 and February 2011, a total of 1254 patients with preoperative sinus rhythm who underwent open cardiac surgery were included of which 177 (13.6%) had developed POAF. Many clinical variables that are associated with the development of POAF, were evaluated. RESULTS: The study population consisted of 1254 patients that 864 (68.9%) were male and 390 (31.1%) female, and average age was 55.1±15.7 years. POAF occurred in 171 (13.6%) of patients and most of them (68.4%) developed within the first two days after surgery. Multivariate logistic regression analysis was used to identify the following risk factors of POAF: Preoperative risk factors: age>50, smoking, Left ventricular hypertrophy, renal dysfunction, intraoperative risk factors: intraoperative inotrope use, valve surgery, atrial septal defect (ASD) surgery, bicaval cannulation, concomitant cardiac venting of pulmonary and aorta, longer cardiopulmonary time, longer cross-clamp time, postoperative use of inotropic agent after termination of cardiopulmonary bypass. CONCLUSION: POAF is the most common arrhythmia after cardiac surgery and not only concerted effort should be performed to identify and to reduce the risk factors, but also effective treatment is necessary to prevent mortality and morbidity.

Risk factors and outcomes of acute renal failure after open cardiac surgery.

The incidence, risk factors, and outcome of acute renal failure following open cardiac surgery were assessed prospectively in 5,164 consecutive patients undergoing open heart surgery between March 2006 and February 2011. Acute postoperative renal failure (creatinine>1.5 mg·dL(-1) within 3 days after surgery) developed in 64 (1.2%) patients with normal preoperative renal function (study group). A control group of 238 cardiac surgery patients who had postoperative creatinine levels≤1.5 mg·dL(-1) were selected randomly during the study period. A prospective case-control analysis of these 302 patients was performed. The mean age was 56.3±12.5 years; 191 (63.2%) were men and 111 (36.8%) were women. Pre-, intra- and postoperative risk factors for acute renal failure were evaluated. Of the patients who developed acute renal failure, 12 (18.8%) died postoperatively, which was significantly higher than the 2.1% mortality among those without acute renal failure. Five of the 10 patients (50%) who needed dialysis died. The most significant prognostic factor for mortality was cardiac dysfunction. This study confirmed that impairment of renal function after cardiac surgery is uncommon without preoperative renal impairment, but carries an increased mortality rate.

Chronic lymphocytic leukemia in the recent 10 years and treatment effects of Fludarabin.

OBJECTIVE: CLL (Chronic Lymphocytic Leukemia) is the most common form of leukemia in the western world and because of prolonged survival of patients, the prevalence is high. Chemotherapy is usually not indicated in early and stable disease and using Chlorambucil with or without steroids has been the drug of choice in the treatment of CLL for many years . Clinical studies have shown that using Fludarabin can cause a complete response in significant number of untreated and/or previously treated CLL patients. The aim of this study is evaluating of CLL patients and determining the effects of treatment with Fludarabin. METHODS: A retrospective (descriptive/cross sectional) study of CLL patients who admitted to Hematology and Oncology Research Center of Tabriz university of Medical Sciences, between 1995-2005 was made and 126 patients enrolled. Collection of data was carried out according to special questionnaire and response to Fludarabin was analyzed by SPSS 11 software. RESULTS: The patients mean age of diagnosis was 63.7 years (SD=8.9), 69.8% were males. Illness and fatigue were the commonest presenting symptoms in 54% and lymphadenopathy was the most common clinical sign in 88.9%. Most of the patients were in stage C in Binet system (52.4%) and/or stage IV in Rai system (44.4%). Chemotherapy with chlorambucil and Prednisolone was the most common regimen used (60.3%) and 49.2% of patients were in partial remission with this treatment. Forty two patients treated with Fludarabin and 50% were in partial remission, 35% in static disease, 10% in progressive disease and 5% in complete remission (P=0.053). CONCLUSION: The median survival with Fludarabin was 43.9 months (SD=27.2) and in the case of Chlorambucil+Prednisolone and CVP or Chop it was 45 months (SD=26.5) and 50 months (SD=32.2), respectively (P>0.05). P value in the relationship with survival and response to Fludarabin was more than 0.05. Above all, Fludarabin is the choice treatment as first and second line therapy, as well as for patients who have failed therapy with standard regimens.