title: Does totally endoscopic access for off-pump cardiac surgery influence the incidence of postoperative atrial fibrillation in coronary artery bypass grafting? A preliminary report.
abstract: BACKGROUND
  The occurrence rate of atrial fibrillation (AF) after coronary artery bypass grafting, quoted in the literature, is wide ranging from 5% to over 40%. It is speculated that, off-pump coronary artery bypass grafting (OPCAB) and also minimally invasive cardiac surgery reduces the incidence of postoperative AF due to reduced trauma, ischemia, and inflammation. Current data, however, do not clearly answer the question, whether the incidence of postoperative AF is reduced in using minimally invasive techniques, ideally resulting in the combination of both small access and off-pump surgery. The aim of this study was to evaluate the incidence of postoperative AF in patients undergoing totally endoscopic off-pump coronary artery bypass grafting (TECAB).
  
  
  METHODS
  A retrospective analysis of 72 patients undergoing myocardial revascularization was performed. Early postoperative incidence of AF was compared between three groups of patients: 24 after conventional coronary artery bypass grafting (CABG), 24 after OPCAB, and 24 after totally endoscopic off-pump CABG. Clinical profile of the patients, including factors having potential influence on postoperative AF was matched for groups.
  
  
  RESULTS
  Postoperative AF occurred in 25% of the patients in the CABG group, in 16% of the patients in the OPCAB group, and in 16% of the patients in the TECAB group. This difference has no statistical significance. Risk factors and incidence of postoperative complications were comparable in all groups excepting the number of distal anastomoses. There was a statistical significance between CABG group and TECAB group.
  
  
  CONCLUSIONS
  Avoiding cardiopulmonary bypass and minimizing surgical trauma did not reduce the incidence of postoperative AF in this patient collective. It remains an attractive hypothesis that postoperative AF is reduced by off-pump myocardial revascularisation and minimizing surgical trauma but more robust data are required.
authors.affiliation: Department of Thoracic and Cardiovascular Surgery, J. W. Goethe University, Theodor-Stern-Kai 7, 60590, Frankfurt am Main, Germany. M.Scherer@em.uni-frankfurt.de
authors.forename: Mirela
authors.initials: M
authors.lastname: Scherer
authors.forename: Abdul Sami
authors.initials: AS
authors.lastname: Sirat
authors.forename: Selami
authors.initials: S
authors.lastname: Dogan
authors.forename: Tayfun
authors.initials: T
authors.lastname: Aybek
authors.forename: A
authors.initials: A
authors.lastname: Moritz
authors.forename: G
authors.initials: G
authors.lastname: Wimmer-Greinecker
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000453:epidemiology*; D047549:Coronary Artery Bypass, Off-Pump / Q000706:statistics & numerical data*; D004724:Endoscopy / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D011183:Postoperative Complications / Q000453:epidemiology*; D012189:Retrospective Studies; D018570:Risk Assessment / Q000379:methods*; D012307:Risk Factors; D025321:Surgery, Computer-Assisted / Q000706:statistics & numerical data*; D016896:Treatment Outcome