Prediction of Postcoronary Artery Bypass Grafting Atrial Fibrillation: POAFRiskScore Tool.

BACKGROUND: Atrial fibrillation (AF), a condition that might occur after a heart bypass procedure, has caused differing estimates of its occurrence and risk. The current study analyses the possible risk factors of post-coronary artery bypass grafting (post-CABG) AF (postoperative AF [POAF]) and presents a software for preoperative POAF risk prediction. METHODS: This retrospective research was performed on 1,667 patients who underwent CABG surgery using the hospital database. The associations between the variables of the patients and AF risk factors after CABG were examined using multivariable logistic regression (LR) after preprocessing the relevant data. The tool was designed to predict POAF risk using Shiny, an R package, to develop a web-based software. RESULTS: The overall proportion of post-CABG AF was 12.2%. According to the results of univariate tests, in terms of age (p < 0.001), blood urea nitrogen (p = 0.005), platelet (p < 0.001), triglyceride (p = 0.0026), presence of chronic obstructive pulmonary disease (COPD; p = 0.01), and presence of preoperative carotid artery stenosis (PCAS; p < 0.001), there were statistically significant differences between the POAF and non-POAF groups. Multivariable LR analysis disclosed the independent risk factors associated with POAF: PCAS (odds ratio [OR] = 2.360; p = 0.028), COPD (OR = 2.243; p = 0.015), body mass index (OR = 1.090; p = 0.006), age (OR = 1.054, p < 0.001), and platelet (OR = 0.994, p < 0.001). CONCLUSION: The experimental findings from the current research demonstrate that the suggested tool (POAFRiskScore v.1.0) can help clinicians predict POAF risk development in the preoperative period after validated on large sample(s) that can represent the related population(s). Simultaneously, since the updated versions of the proposed tool will be released periodically based on the increases in data dimensions with continuously added new samples and related factors, more robust predictions may be obtained in the subsequent stages of the current study in statistical and clinical terms.

Is There Any Difference in Risk Factors between Male and Female Patients in New-Onset Atrial Fibrillation after Coronary Artery Bypass Grafting?

BACKGROUND: We aimed to investigate the risk factors of post-coronary artery bypass grafting (CABG) atrial fibrillation (AF) in male and female patients without any history of AF, to identify the sex-specific risk factors, and to examine the effect of sex-specific risk factors on the overall population. METHODS: This retrospective study was conducted using the hospital database with 4,758 patients who underwent CABG surgery. Among them, 2,836 patients with complete data participated in this study. The female patients were divided into two groups as patients who developed new-onset AF after CABG and those who did not. The relationship between the patients' variables and risk factors of post-CABG AF was examined. RESULTS: The overall incidence of post CABG AF was 12.9% (386/2,836). Sex-specific incidence of AF was similar: 3.2% (91/690) and 12.9% (277/2146) in female and male patients, respectively (p = 0.849). Multiple analysis revealed the independent risk factors for male and female patients, respectively: mean age (odds ratio [OR] = 1.057, OR = 1,076), age over 65 years (OR = 2.156, OR = 2.736), the European System For Cardiac Operative Risk Evaluation Scores (EuroSCORE) (OR = 1.13, OR = 1.218), COPD (OR = 1.589, OR = 1.789), BUN level (OR = 1.026, OR = 1.019), mean cardiopulmonary bypass (CPB) time (OR = 1.007, OR = 1.010), prolonged CPB time (OR = 1.604, OR = 2.309), mean cross-clamp time (OR = 1.009, OR = 1.017), need of inotropic support (OR = 2.249, OR = 2.731), and mean mechanical ventilation time (VT) (OR = 1.026, OR = 1.027).Low left ventricular ejection fraction (LVEF) (OR = 1.419), left ventricular (LV) aneurysm repair (OR = 1.533), carotid artery disease (OR = 1.750), prolonged VT (OR = 1.729), and use of intra-aortic balloon pump (IABP) (OR = 2.436) were found to be the risk factors only for male AF patients.Unstable angina (OR = 1.969), right coronary artery (RCA) disease (OR = 2), prolonged cross-clamp time (OR = 2.152), and the number of grafts per operation (OR = 1.298) were found to be the risk factors only for female AF patients. CONCLUSION: This study suggests that predictors of AF in the overall population may be due to isolated patient groups. Multiple regression analysis and artificial intelligence modelling should be performed on large-scale, isolated groups to make strong AF prediction.

The Surgical Repair of a Hyperimmunoglobulin E Syndrome Associated Ascending Aortic Aneurysm.

Hyperimmunoglobulin E syndrome (HIES) is an immunodeficiency disorder that manifests itself by affecting more than one system. Arterial aneurysms are among the significant complications associated with HIES. Surgical procedures for patients with such aneurysms are uncommon. In this study, we aim to present the case and surgical repair of a male child who was previously diagnosed with HIES and presented with rapidly expanding ascending aortic aneurysm.

The effects of pulmonary hypertension on early outcomes inpatients undergoing coronary artery bypass surgery.

BACKGROUND/AIM: To investigate the effects of pulmonary hypertension on early clinical variables in patients undergoing coronary artery bypass grafting surgery. MATERIALS AND METHODS: The preoperative echocardiographic data of patients who underwent isolated coronary artery bypass surgery were evaluated retrospectively. A total of 1244 patients were included in the study. The patients were divided into two groups: one group consisted of patients with systolic pulmonary artery pressure (SPAP) values equal to or greater than 30 mmHg (Group 1, n = 184), while the other group consisted of patients with SPAP values below 30 mmHg (Group 2, n = 1060). RESULTS: Early mortality was similar in both groups (0% in Group 1 and 1.2% in Group 2; P > 0.05). Comparison of postoperative data indicated that Group 1 had a higher need for inotropic agent treatment, a longer average duration of ventilation, and a longer average duration of stay in the intensive care unit (P < 0.05). For the other variables, no significant differences were identified between patients with and without pulmonary hypertension (P > 0.05). CONCLUSION: Mild pulmonary hypertension (mean SPAP = 37.7 ± 8.4 mmHg) was not associated with a significant difference in the mortality of patients undergoing coronary artery bypass grafting. For patients undergoing this type of coronary bypass surgery, lower morbidity and mortality rates can be achieved through comprehensive preoperative examinations and effective perioperative medical procedures.

Coronary Bypass Surgery in Patients with Pulmonary Hypertension: Assessment of Early and Long Term Results.

PURPOSE: We aimed to evaluate the effects of preoperative pulmonary hypertension (PH) on early and long term results in patients undergoing coronary bypass surgery and the effects of coronary bypass surgery on PH. METHODS: Among 2325 patients who underwent elective isolated coronary artery bypass surgery between March 2003 and March 2012, 287 patients with high preoperative pulmonary arterial pressure (PAP) ≥30 mmHg were examined. Patients' data were obtained by retrospective examination of our clinic's database. 69 patients who had complete parameters included in the study. RESULTS: There was no increase in the New York Heart Association (NYHA) functional classification 84% of cases. Preoperative and postoperative values of the mean ejection fraction and mean PAP of patients was respectively 45.28 ± 9.67 (25-65), 46.03 ±12.4 (20-65) (p = 0.447), 36.67 ± 6.81 (30-60) mmHg, 37.81 ± 10.07 (20-70) mmHg (p = 0.378). The late mortality of cases was 5.79%. In our study, during 33.9 ± 17 (9-100) months follow up period, life expectancy was calculated as 94.7 months. CONCLUSION: Preoperative evaluation of these patients for appropriate medical treatment at peroperative and postoperative period, coronary bypass can be performed with low morbidity and mortality rates. In the late period after surgical revascularization PH showed no significant change and had no adverse effect on quality of life.

Large thrombus formation from right atrial incision site after closure of atrial septal defect.

Atrial septal defect (ASD) is the common congenital anomaly which requires surgical interventions. Right atrial thrombus formations after primary suture repairs of the ASD and evidences of thromboembolic complications are extremely rare. Specifically, the cases of thromboembolic complications have high mortality and morbidity risks. Two cases of giant intra-atrial thrombus formation detected in the late stage after primary repairs of ASDs are being discussed.