Features of intraoperative management during heart surgery affecting the development of postoperative atrial fibrillation

Objective: to determine whether the features of the performed cardiac surgery influence the development of atrial fibrillation in the early postoperative period. Materials and methods: the study included patients operated on in the Cardiac Surgery Department No. 2 of the Research Institute — Regional Clinical Hospital No. 1 of Krasnodar in the period from July 1, 2022 to January 1, 2023. During the analyzed period of time, open heart surgery was performed in 552 patients, 60 of whom had postoperative atrial fibrillation (this cohort was called the main group A). Sinus rhythm was recorded in 424 patients, and therefore, using a random number generator, a comparison group (group B) identical in number to the main group was formed, which consisted of 64 patients. Results: in total, 60 patients (10.9%) developed atrial fibrillation in theearly postoperative period, on average on the 3rd postoperative day (range 1–6 days). Evaluation of the performed surgical intervention showed that patients with postoperative atrial fibrillation more often underwent heart valve replacement surgery or combined prosthetic valve surgery with bypass grafting. If isolated coronary surgery was performed, patients were more likely to tolerate cardiopulmonary bypass, had a longer aortic clamping time, and underwent multivessel bypass with two or more anastomoses. Conclusion: it is extremely important to find predictors of postoperative atrial fibrillation and, by successfully acting on them, to minimize the likelihood of developing a stroke as a complication of atrial fibrillation, without prolonging the length of stay in the hospital and preventing the burden of such severe consequences of a stroke on the patient’s body and on the healthcare system as a whole, such as severe neurological deficit and disability.