POAF is a big deal and PleuraFlow use to prevent Retained Blood is associated with big decreases in POAF

Share this far and wide – and remember that use of PleuraFlow after cardiac surgery has been clinically shown to reduce the odds of POAF emerging after cardiac surgery by 50% or better. The POAF incidence number mentioned here of 20% is for stand-alone CABG. It’s 40-50% for CABG/Valve procedures!

https://www.medscape.com/viewarticle/892838

<<Atrial fibrillation (AF) develops in almost one in five patients after left main coronary artery bypass surgery and is one of the strongest predictors for subsequent stroke and death, a post hoc analysis of the EXCEL study suggests.

Three years after coronary artery bypass surgery (CABG), the adjusted risk for all-cause death was threefold higher, stroke fourfold higher, and cardiovascular death nearly fivefold higher in those with postoperative atrial fibrillation (POAF).

"It's fairly common knowledge that atrial fibrillation after bypass surgery of any sort is fairly common but in terms of how consequential it is, that's relatively unknown territory," senior author, Gregg Stone, MD, from Columbia University Medical Center in New York City, told theheart.org | Medscape Cardiology. "I think this report really sheds a light on how potentially important atrial fibrillation after bypass surgery is."

The analysis was published in the February 20 issue of the Journal of the American College of Cardiology.

The EXCEL study compared CABG and percutaneous coronary intervention (PCI) with an everolimus-eluting stent in patients with left main coronary artery disease (CAD) and low- or intermediate-risk SYNTAX scores (≤32). As reported in 2016, the two revascularization strategies were similar for the primary composite endpoint of all-cause mortality, stroke, or myocardial infarction (MI) at 3 years.

The new analysis found that new-onset AF developed at a mean of 2.7 days after revascularization in 162 patients (8.9%). All but one episode occurred in those treated with CABG (18% vs 0.1%; P < .0001).

Patients with POAF spent nearly twice as long in the hospital as those without POAF (14.3 vs 8.3 days; P < .0001), with 20 patients undergoing cardioversion.

At discharge, 85.8% of patients had reverted to normal sinus rhythm. [Molloy – 15% still have POAF at discharge!]

At 30 days, however, the adjusted risk for the composite of death, MI, or stroke was higher in patients with POAF than in those without.

At 3 years, POAF was independently associated with stroke (hazard ratio [HR], 4.19; 95% CI, 1.74 - 10.11), all-cause death (HR, 3.02; 95% CI, 1.60 - 5.70), and cardiovascular death (HR, 4.86; 95% CI, 2.27 - 10.44).

"This data is strong enough for patients who have a high CHADsVASC score and have developed an episode of atrial fibrillation in the post-CABG phase to highly or strongly consider long-term chronic oral anticoagulation," Stone said.

"And I think these patients deserve very close surveillance and monitoring to look for recurrent atrial arrhythmias and even potentially in the future, depending on their risk of AF vs hemorrhagic events, consider either left atrial appendage occlusion or ablation," he added.

A Call to Arms

Of special note, none of the patients with POAF were prescribed novel oral anticoagulants at discharge, and only 10.1% were sent home with warfarin. Aspirin was near-universal in both groups>>.