DÜŞÜK HACIMLI BIR MERKEZDE POMPASIZ VE POMPALI KORONER ARTER BAYPAS GREFTLEME SONRASI POSTOPERATIF ATRIYAL FIBRILASYONUN KARŞILAŞTIRILMASI

Background: Postoperative atrial fibrillation (POAF) remains the most common complication following coronary artery bypass grafting (CABG) and is associated with increased morbidity, prolonged hospitalization, and higher healthcare costs. The potential benefit of off-pump CABG (OPCAB) in reducing POAF remains controversial, particularly in low-volume centers. Objective: To compare the incidence of postoperative atrial fibrillation and early clinical outcomes between off-pump (OPCAB) and on-pump CABG (ONCAB) in a low-volume cardiac surgery center and to evaluate perioperative factors associated with POAF. Methods: In this retrospective single-center study, 200 consecutive patients undergoing isolated CABG between November 2017 and August 2019 were analyzed (100 OPCAB, 100 ONCAB). Patients with prior atrial fibrillation, concomitant cardiac procedures, or emergency surgery were excluded. POAF was defined as new-onset atrial fibrillation lasting ≥10 minutes or requiring treatment during hospitalization. Clinical, operative, and biochemical variables including serial C-reactive protein (CRP) levels were recorded. Multivariable logistic regression analysis was performed to identify independent predictors of POAF. Results: POAF occurred in 26% of patients in the ONCAB group and 16% in the OPCAB group (p=0.300). AF episodes occurred predominantly on postoperative days 2–3. Duration of AF was significantly shorter in the ONCAB group compared with OPCAB (5.33±1.86 vs 7.55±1.94 hours, p=0.023), while ICU stay, ventilation time, and hospital length of stay were comparable between groups. CRP levels increased significantly postoperatively in both cohorts, peaking on day 2, but were consistently lower in the OPCAB group (p<0.05). In multivariable analysis, cardiopulmonary bypass use (OR 4.28, 95% CI 1.49–12.26, p=0.007) was identified as an independent predictor of POAF, while age showed a borderline association. No AF-related mortality, stroke, or major complications were observed. Conclusion: In this low-volume center, OPCAB did not significantly reduce the incidence of postoperative atrial fibrillation compared with ONCAB, despite lower inflammatory response as reflected by CRP levels. These findings suggest that POAF is multifactorial and more strongly influenced by patient-related and perioperative factors than by surgical technique alone.