POSTOPERATIVE ATRIAL FIBRILLATION AFTER CORONARY BYPASS SURGERY IN PATIENTS HAVING PRE-OPERATIVE HYPOALBUMINEMIA
DOI:
https://doi.org/10.55519/JAMC-04-11891Keywords:
hypo-albuminuria, coronary bypass surgery, post-operative atrial fibrillationAbstract
Background: Hypoalbuminemia commonly occurs in cardiac patients, especially in elderly patients and those with chronic congestive heart failure, and it has been associated with adverse events such as atrial fibrillation. The study aimed to determine the incidence of postoperative atrial fibrillation (POAF) in patients undergoing coronary bypass surgery (CABG) with pre-operative hypoalbuminemia in a major cardiac surgery institute in Karachi, Pakistan. Methods: This descriptive cross-sectional study included patients of any gender, aged between 30–80 years, who underwent CABG surgery and had hypoalbuminemia at the time of pre-operative assessment. Hypoalbuminemia was defined as a serum albumin level less than 3.8 mg/dL (normal range: 3.8–4.5 mg/dL). We recorded routine daily 12-lead ECGs and monitored the occurrence of POAF within 72 hours of surgery. Results: A total of 144 patients were included in the study, of which 77.8% (112) were male, and the mean age was 58.1±8.4 years. The average serum albumin levels before surgery were 3.5±0.2 mg/dL. The majority of patients, 71.5% (103), had three-vessel disease (3VD), and 20.8% (30) had 3VD with left main (LM) disease. Hypertension was observed in 70.1% (101) of the patients, diabetes in 52.1% (75), and prolonged CBP time in 61.8% (89). The frequency of POAF was 10.4% (15), and it was significantly higher in non-hypertensive and non-diabetic patients, with a crude odds ratio of 4.19 [1.39–12.65] and 8.47 [1.84–39.09], respectively. Conclusion: The study found that approximately one in every ten patients undergoing CABG experienced POAF. Surprisingly, the rate of POAF was higher among non-hypertensive and non-diabetic patients.References
Chien SC, Chen CY, Lin CF, Yeh HI. Critical appraisal of the role of serum albumin in cardiovascular disease. Biomark Res 2017;5(1):1–9.
Ferencesy A, Diller GP, Alonso-Gonzalez R, Uebing A, Rafiq I, Li W, et al. Hypoalbuminaemia predicts outcome in adult patients with congenital heart disease. Heart 2015;101(9):699–705.
Arques S, Ambrosi P. Human serum albumin in the clinical syndrome of heart failure. J Card Fail 2011;17(6):451–8.
Fagyas M, Úri K, Siket IM, Fülöp GÁ, Csato V, Daragó A, et al. New perspectives in the renin-angiotensin-aldosterone system (RAAS) II: albumin suppresses angiotensin converting enzyme (ACE) activity in human. PLoS One 2014;9(4):e87844.
D’Agostino RS, Jacobs JP, Badhwar V, Fernandez FG, Paone G, Wormuth DW, et al. The society of thoracic surgeons adult cardiac surgery database: 2018 update on outcomes and quality. Ann Thorac Surg 2018;105(1):15–23.
Guajardo Salinas GE, Nutt R, Rodriguez-Araujo G. Del Nido cardioplegia in low risk adults undergoing first time coronary artery bypass surgery. Perfusion 2017;32(1):68–73.
Aranki SF, Shaw DP, Adams DH, Rizzo RJ, Couper GS, VanderVliet M, et al. Predictors of atrial fibrillation after coronary artery surgery. Current trends and impact on hospital resources. Circulation 1996;94(3):390–7.
Shen J, Lall S, Zheng V, Buckley P, Damiano RJ, Jr Schuessler RB. The persistent problem of new-onset postoperative atrial fibrillation: a single-institution experience over two decades. J Thorac Cardiovasc Surg 2011;141(2):559–70.
Badhwar V, Rankin JS, Ad N, Grau-Sepulveda M, Damiano RJ, Gillinov AM, et al. The society of thoracic surgeons adult cardiac surgery database: 2019 update on outcomes and quality. Ann Thorac Surg 2019;107:24–32.
Lee EH, Kim WJ, Kim JY, Chin JH, Choi DK, Sim JY, et al. Effect of Exogenous Albumin on the Incidence of Postoperative Acute Kidney Injury in Patients Undergoing Off-pump Coronary Artery Bypass Surgery with a Preoperative Albumin Level of Less Than 4.0 g/dl. Anesthesiology. 2016;124:1001–11.
Berbel-Franco D, Lopez-Delgado JC, Putzu A, Esteve F, Torrado H, Farrero E, et al. The influence of postoperative albumin levels on the outcome of cardiac surgery. J Cardiothorac Surg 2020;15(1):78.
Hussain SM, Zia K, Mangi AR, Shirazi Z, Ahmed A, Kumar K, et al. Operative Mortality of Coronary Artery Bypass Grafting in Patients with Low Serum Albumin after Nutritional Support. Pak Heart J 2021;54(03):235–8.
Akgul E, Parlar AL, Erkul G, Erkul Sİ, Cekirdekci AH. Investigation of the effect of preoperative hypoalbuminemia, blood urea nitrogen and creatinine levels on postoperative atrial fibrillation on off-pump coronary bypass surgery patients. Heart Surg Forum 2020;23(5):E641–6.
Mostafa A, El-Haddad MA, Shenoy M, Tuliani T. Atrial fibrillation post cardiac bypass surgery. Avicenna J Med 2012;2(3):65–70.
Engelman DT, Ali WB, Williams JB, Perrault LP, Reddy VS, Arora RC, et al. Guidelines for perioperative care in cardiac surgery: enhanced recovery after surgery society recommendations. JAMA Surg 2019;154(8):755–66.
Yadava M, Hughey AB, Crawford TC. Postoperative atrial fibrillation: incidence, mechanisms, and clinical correlates. Heart Fail Clin 2016;12:299–308.
Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflam mation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015;154:13–20.
Li N, Qiao H, Guo JF, Yang HY, Li XY, Li SL, et al. Preoperative hypoalbuminemia was associated with acute kidney injury in high-risk patients following non-cardiac surgery: a retrospective cohort study. BMC Anesthesiol 2019;19(1):171.
Mathew JP, Fontes ML, Tudor IC, Ramsay J, Duke P, Mazer CD, et al. A multicenter risk index for atrial fibrillation after cardiac surgery. JAMA 2004;291(14):1720–9.
Nazeri A, Razavi M, Elayda MA, Lee VV, Massumi A, Wilson JM. Race/ethnicity and the incidence of new-onset atrial fibrillation after isolated coronary artery bypass surgery. Heart Rhythm 2010;7(10):1458–63.
Rader F, Van Wagoner DR, Ellinor PT, Gillinov AM, Chung MK, Costantini O, et al. Influence of race on atrial fibrillation after cardiac surgery. Circ Arrhythm Electrophysiol 2011;4(5):644–52.
Benjamin EJ, Levy D, Vaziri SM, D'Agostino RB, Belanger AJ, Wolf PA. Independent risk factors for atrial fibrillation in a population-based cohort: the Framingham Heart Study. JAMA 1994;271(11):840–4.
Tadic M, Ivanovic B, Zivkovic N. Predictors of atrial fibrillation following coronary artery bypass surgery. Med Sci Monit 2011;17(1):CR48–55.
Mueller XM, Tevaearai HT, Ruchat P, Stumpe F, Von Segesser LK. Atrial fibrillation and minimally invasive coronary artery bypass grafting: risk factor analysis. World J Surg 2002;26(6):639–42.
Kalus JS, White CM, Caron MF, Coleman CI, Takata H, Kluger J. Indicators of atrial fibrillation risk in cardiac surgery patients on prophylactic amiodarone. Ann Thorac Surg 2004;77(4):1288–92.
Kinoshita T, Asai T, Suzuki T, Kambara A, Matsubayashi K. Preoperative hemoglobin A1c predicts atrial fibrillation after off-pump coronary bypass surgery. Eur J Cardiothorac Surg 2012;41(1):102–7.
Zhao H, Liu M, Chen Z, Mei K, Yu P, Xie L. Dose-response analysis between hemoglobin A1c and risk of atrial fibrillation in patients with and without known diabetes. PLoS One 2020;15(2):e0227262.
Abbaszadeh S, Shafiee A, Bina P, Jalali A, Sadeghian S, Karimi A. Preoperative hemoglobin A1c and the occurrence of atrial fibrillation following on-pump coronary artery bypass surgery in type-2 diabetic patients. Crit Pathw Cardiol 2017;16(1):37–41.
Malhotra P, Pande S, Mahindru S, Thukral A, Kotwal AS, Gupta RP, et al. Postoperative atrial fibrillation in coronary artery bypass grafting herald poor outcome. Ann Card Anaesth 2021;24:464–9.
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