Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation.
OBJECTIVE
Postcardiopulmonary bypass atrial fibrillation remains a constant complication associated with coronary revascularization, the incidence of which occurs from 20% to 35%. Previous studies have addressed this problem in the postoperative setting utilizing pharmacological agents, but the results have been variable. The purpose of this study was to evaluate a novel intraoperative strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation. We theorized that leukocyte depletion by filtration with the addition of aprotinin would reduce the systemic inflammatory effects of bypass and reduce the incidence of atrial fibrillation.


METHODS
One hundred and twenty-two patients participated in this randomized study. Only isolated primary coronary revascularization procedures on cardiopulmonary bypass were included. The control group (n=55) received standard moderate hypothermic blood cardioplegia cardiopulmonary bypass. The treatment group (n=65) received similar cardiopulmonary bypass with the addition of strategic leukocyte depletion with Pall Biomedical Products (East Hills, NY) leukodepletion filters and full-dose aprotinin.


RESULTS
The intraoperative addition of leukocyte depletion by filtration with aprotinin reduced the incidence of postcardiopulmonary bypass atrial fibrillation by 72%. The incidence.of atrial fibrillation in the control group was 27% (15 of 55). In contrast, the occurrence of atrial fibrillation in the treated group was only 7.6% (5 of 65) (p<0.025).


CONCLUSIONS
This novel intraoperative treatment strategy of both mechanical (leukocyte filtration) and pharmacological (aprotinin) intervention appears to markedly reduce the incidence of postcardiopulmonary bypass atrial fibrillation. To our knowledge, this is the first study to combine these two treatment strategies. A previous study has noted a decline in atrial fibrillation with aprotinin in the animal model, but not to the extent observed in our study. The beneficial effects of the reduction of atrial fibrillation include reduced risk of emboli formation and the incidence of ischemia in the heart, lung and brain. In addition, a decrease in length of hospital stay, recovery time and overall cost occurred.
Olivencia-Yurvati
A H
AH
Department of Surgery and the Cardiovascular Research Institute, University of North Texas Health Science Center, Fort Worth, USA. hyper-al@worldnet.alt.net
Wallace
W E
WE
Wallace
N
N
Dimitrijevich
D
D
Knust
J K
JK
Haas
L
L
Raven
P B
PB
D007611:Aprotinin / Q000627:therapeutic use*; D001281:Atrial Fibrillation / Q000209:etiology* / Q000517:prevention & control*; D001026:Coronary Artery Bypass / Q000009:adverse effects*; D006440:Hemofiltration; D006490:Hemostatics / Q000627:therapeutic use*; D006801:Humans; D007430:Intraoperative Care; D007937:Leukapheresis / Q000379:methods*; D016896:Treatment Outcome
D006490:Hemostatics; D007611:Aprotinin