Subscribe to RSS
DOI: 10.1055/s-0034-1367081
Atrial fibrillation in patients undergoing on-pump or off-pump coronary surgery - lessons learned from GOPCABE
Objective: We sought to find out whether in patients with AF before surgery, off-pump coronary artery bypass surgery (CABG) is able to decrease the perioperative risk compared to on-pump surgery and whether off-pump myocardial revascularization prevents from postoperative atrial fibrillation (AF).
Patients and methods: From 2394 patients out of the German Off Pump Coronary Artery Bypass Grafting in Elderly Patients (GOPCABE) study, 120 patients in the on-pump group (9.9% ) and 112 patients (9.4%) in the off-pump group were in AF preoperatively and were included into the analysis.
Results: From the 1207 patients in the on-pump group, 123 patients (10.2%) had AF at the time of discharge, from the 1187 patients in the off-pump group, 121 patients (10.2%) had AF at the time of discharge. Off-pump or on-pump surgery in patients with AF yields clinically worse results than in patients with SR: the combined endpoint (Death, infarction, stroke, dialysis, revascularisation) occurred more frequently (p = 0.008) in AF Patients (10% after on-pump surgery, 16.1% after off-pump surgery) than in SR patients (8.1% after on-pump surgery, 6.9% after off-pump surgery). 30-day mortality was significantly (p = 0.003) higher in AF Patients (4.2% after on-pump surgery, 8.0% after off-pump surgery) than in SR patients (2.7% after on-pump surgery, 2.1% after off-pump surgery).
Conclusions: The rate of patients in AF after surgery is not different between on-and off pump surgery. Because AF patients carry a higher preoperative risk they show a higher mortality after surgery. Off-pump surgery does not decrease the perioperative risk of AF patients compared to on-pump surgery.