Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation

Albert Yurvati, W. E. Wallace, N. Wallace, D. Dimitrijevich, J. K. Knust, L. Haas, P. B. Raven

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Abstract

Purpose: 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.

Original languageEnglish
Pages (from-to)35-39
Number of pages5
JournalPerfusion
Volume17
Issue numberSUPPL.
DOIs
StatePublished - 15 May 2002

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Atrial Fibrillation
incidence
Aprotinin
Incidence
Leukocytes
Cardiopulmonary Bypass
Brain
Animals
Blood
Therapeutics
Group
Recovery
Length of Stay
Pharmacology
Costs
Induced Heart Arrest
Control Groups
brain
Embolism
animal

Cite this

Yurvati, A., Wallace, W. E., Wallace, N., Dimitrijevich, D., Knust, J. K., Haas, L., & Raven, P. B. (2002). Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation. Perfusion, 17(SUPPL.), 35-39. https://doi.org/10.1191/0267659102pf552oa
Yurvati, Albert ; Wallace, W. E. ; Wallace, N. ; Dimitrijevich, D. ; Knust, J. K. ; Haas, L. ; Raven, P. B. / Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation. In: Perfusion. 2002 ; Vol. 17, No. SUPPL. pp. 35-39.
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abstract = "Purpose: 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.",
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Yurvati, A, Wallace, WE, Wallace, N, Dimitrijevich, D, Knust, JK, Haas, L & Raven, PB 2002, 'Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation', Perfusion, vol. 17, no. SUPPL., pp. 35-39. https://doi.org/10.1191/0267659102pf552oa

Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation. / Yurvati, Albert; Wallace, W. E.; Wallace, N.; Dimitrijevich, D.; Knust, J. K.; Haas, L.; Raven, P. B.

In: Perfusion, Vol. 17, No. SUPPL., 15.05.2002, p. 35-39.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Intraoperative treatment strategy to reduce the incidence of postcardiopulmonary bypass atrial fibrillation

AU - Yurvati, Albert

AU - Wallace, W. E.

AU - Wallace, N.

AU - Dimitrijevich, D.

AU - Knust, J. K.

AU - Haas, L.

AU - Raven, P. B.

PY - 2002/5/15

Y1 - 2002/5/15

N2 - Purpose: 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.

AB - Purpose: 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.

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U2 - 10.1191/0267659102pf552oa

DO - 10.1191/0267659102pf552oa

M3 - Article

VL - 17

SP - 35

EP - 39

JO - Perfusion

JF - Perfusion

SN - 0267-6591

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