Risk factors for arrhythmia after robotic cardiac surgery: A retrospective cohort study_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

WU Wenjun , DING Renzhong , CHEN Jianming , YUAN Ye , SONG Yi , YAN Manrong ,  HU Yijie

Department of Cardiovascular Surgery, Daping Hospital, Army Medical University, Chongqing, 400042, P. R. China;

Corresponding author：

HU Yijie, Email: cts_hu@163.com

Keywords：

Robotic surgery; cardiac surgery; cardiopulmonary bypass; arrhythmia; risk factors

DOI：

10.7507/1007-4848.202208023

Video：

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Objective To investigate the risk factors for arrhythmia after robotic cardiac surgery. Methods The data of the patients who underwent robotic cardiac surgery under cardiopulmonary bypass (CPB) from July 2016 to June 2022 in Daping Hospital of Army Medical University were retrospectively analyzed. According to whether arrhythmia occurred after operation, the patients were divided into an arrhythmia group and a non-arrhythmia group. Univariate analysis and multivariate logistic analysis were used to screen the risk factors for arrhythmia after robotic cardiac surgery. Results A total of 146 patients were enrolled, including 55 males and 91 females, with an average age of 43.03±13.11 years. There were 23 patients in the arrhythmia group and 123 patients in the non-arrhythmia group. One (0.49%) patient died in the hospital. Univariate analysis suggested that age, body weight, body mass index (BMI), diabetes, New York Heart Association (NYHA) classification, left atrial anteroposterior diameter, left ventricular anteroposterior diameter, right ventricular anteroposterior diameter, total bilirubin, direct bilirubin, uric acid, red blood cell width, operation time, CPB time, aortic cross-clamping time, and operation type were associated with postoperative arrhythmia (P<0.05). Multivariate binary logistic regression analysis suggested that direct bilirubin (OR=1.334, 95%CI 1.003-1.774, P=0.048) and aortic cross-clamping time (OR=1.018, 95%CI 1.005-1.031, P=0.008) were independent risk factors for arrhythmia after robotic cardiac surgery. In the arrhythmia group, postoperative tracheal intubation time (P<0.001), intensive care unit stay (P<0.001) and postoperative hospital stay (P<0.001) were significantly prolonged, and postoperative high-dose blood transfusion events were significantly increased (P=0.002). Conclusion Preoperative direct bilirubin level and aortic cross-clamping time are independent risk factors for arrhythmia after robotic cardiac surgery. Postoperative tracheal intubation time, intensive care unit stay, and postoperative hospital stay are significantly prolonged in patients with postoperative arrhythmia, and postoperative high-dose blood transfusion events are significantly increased.

Citation： WU Wenjun, DING Renzhong, CHEN Jianming, YUAN Ye, SONG Yi, YAN Manrong, HU Yijie. Risk factors for arrhythmia after robotic cardiac surgery: A retrospective cohort study. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2024, 31(5): 745-750. doi: 10.7507/1007-4848.202208023 Copy

1.	Girdauskas E, Pausch J, Harmel E, et al. Minimally invasive mitral valve repair for functional mitral regurgitation. Eur J Cardiothorac Surg, 2019, 55(Suppl 1): i17-i25.
2.	Darr C, Cheufou D, Weinreich G, et al. Robotic thoracic surgery results in shorter hospital stay and lower postoperative pain compared to open thoracotomy: A matched pairs analysis. Surg Endosc, 2017, 31(10): 4126-4130.
3.	Yanagawa F, Perez M, Bell T, et al. Critical outcomes in nonrobotic vs robotic-assisted cardiac surgery. JAMA Surg, 2015, 150(8): 771-777.
4.	许李力, 李平, 徐屹, 等. 机器人心脏外科手术早期随访的安全性及有效性研究. 机器人外科学杂志(中英文), 2021, 2(6): 421-430.
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6.	Caldonazo T, Kirov H, Rahouma M, et al. Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2023, 165(1): 94-103.
7.	唐义虎, 吴延虎, 周景昕, 等. 达芬奇系统下改良不停跳房间隔缺损修补及学习曲线的临床研究. 中国临床研究, 2020, 33(10): 1314-1319.
8.	Gillinov AM, Mihaljevic T, Javadikasgari H, et al. Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases. J Thorac Cardiovasc Surg, 2018, 155(1): 82-91.
9.	Moss E, Halkos ME, Binongo JN, et al. Prevention of unilateral pulmonary edema complicating robotic mitral valve operations. Ann Thorac Surg, 2017, 103(1): 98-104.
10.	Khan J, Khan N, Loisa E, et al. Increasing occurrence of postoperative atrial fibrillation in contemporary cardiac surgery. J Cardiothorac Vasc Anesth, 2016, 30(5): 1302-1307.
11.	Bessissow A, Khan J, Devereaux PJ, et al. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: An overview. J Thromb Haemost, 2015, 13 Suppl 1: S304-S312.
12.	Todorov H, Janssen I, Honndorf S, et al. Clinical significance and risk factors for new onset and recurring atrial fibrillation following cardiac surgery—A retrospective data analysis. BMC Anesthesiol, 2017, 17(1): 163.
13.	Öztürk E, Kafalı HC, Tanıdır İC, et al. Early postoperative arrhythmias in patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg, 2021, 29(1): 27-35.
14.	Eikelboom R, Sanjanwala R, Le ML, et al. Postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(2): 544-554.
15.	Boons J, Van Biesen S, Fivez T, et al. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery: A narrative review. J Cardiothorac Vasc Anesth, 2021, 35(11): 3394-3403.
16.	Phan K, Khuong JN, Xu J, et al. Obesity and postoperative atrial fibrillation in patients undergoing cardiac surgery: Systematic review and meta-analysis. Int J Cardiol, 2016, 217: 49-57.
17.	Vural Ü, Ağlar AA. What is the role of metabolic syndrome and obesity for postoperative atrial fibrillation after coronary bypass grafting? BMC Cardiovasc Disord, 2019, 19(1): 147.
18.	Jain A, Alam S, Viralam SK, et al. Incidence, risk factors, and outcome of cardiac arrhythmia postcardiac surgery in children. Heart Views, 2019, 20(2): 47-52.
19.	Turkkolu ST, Selçuk E, Köksal C. Biochemical predictors of postoperative atrial fibrillation following cardiac surgery. BMC Cardiovasc Disord, 2021, 21(1): 167.
20.	Chen SC, Chung FP, Chao TF, et al. A link between bilirubin levels and atrial fibrillation recurrence after catheter ablation. J Chin Med Assoc, 2019, 82(3): 175-178.
21.	Mariscalco G, Biancari F, Zanobini M, et al. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: The POAF score. J Am Heart Assoc, 2014, 3(2): e000752.
22.	Zhu Y, Jing W, Lv P, et al. Clinical factors associated with arrhythmia and short-term prognosis following mitral valve repair: A retrospective cohort study. Cardiovasc Diagn Ther, 2022, 12(1): 114-122.
23.	Bramer S, van Straten AH, Soliman Hamad MA, et al. New-onset postoperative atrial fibrillation predicts late mortality after mitral valve surgery. Ann Thorac Surg, 2011, 92(6): 2091-2096.
24.	Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, et al. Atrial fibrillation following cardiac surgery: Risk analysis and long-term survival. J Cardiothorac Surg, 2012, 7: 87.

1. Girdauskas E, Pausch J, Harmel E, et al. Minimally invasive mitral valve repair for functional mitral regurgitation. Eur J Cardiothorac Surg, 2019, 55(Suppl 1): i17-i25.
2. Darr C, Cheufou D, Weinreich G, et al. Robotic thoracic surgery results in shorter hospital stay and lower postoperative pain compared to open thoracotomy: A matched pairs analysis. Surg Endosc, 2017, 31(10): 4126-4130.
3. Yanagawa F, Perez M, Bell T, et al. Critical outcomes in nonrobotic vs robotic-assisted cardiac surgery. JAMA Surg, 2015, 150(8): 771-777.
4. 许李力, 李平, 徐屹, 等. 机器人心脏外科手术早期随访的安全性及有效性研究. 机器人外科学杂志(中英文), 2021, 2(6): 421-430.
5. Gaudino M, Sanna T, Ballman KV, et al. Posterior left pericardiotomy for the prevention of atrial fibrillation after cardiac surgery: An adaptive, single-centre, single-blind, randomised, controlled trial. Lancet, 2021, 398(10316): 2075-2083.
6. Caldonazo T, Kirov H, Rahouma M, et al. Atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. J Thorac Cardiovasc Surg, 2023, 165(1): 94-103.
7. 唐义虎, 吴延虎, 周景昕, 等. 达芬奇系统下改良不停跳房间隔缺损修补及学习曲线的临床研究. 中国临床研究, 2020, 33(10): 1314-1319.
8. Gillinov AM, Mihaljevic T, Javadikasgari H, et al. Early results of robotically assisted mitral valve surgery: Analysis of the first 1000 cases. J Thorac Cardiovasc Surg, 2018, 155(1): 82-91.
9. Moss E, Halkos ME, Binongo JN, et al. Prevention of unilateral pulmonary edema complicating robotic mitral valve operations. Ann Thorac Surg, 2017, 103(1): 98-104.
10. Khan J, Khan N, Loisa E, et al. Increasing occurrence of postoperative atrial fibrillation in contemporary cardiac surgery. J Cardiothorac Vasc Anesth, 2016, 30(5): 1302-1307.
11. Bessissow A, Khan J, Devereaux PJ, et al. Postoperative atrial fibrillation in non-cardiac and cardiac surgery: An overview. J Thromb Haemost, 2015, 13 Suppl 1: S304-S312.
12. Todorov H, Janssen I, Honndorf S, et al. Clinical significance and risk factors for new onset and recurring atrial fibrillation following cardiac surgery—A retrospective data analysis. BMC Anesthesiol, 2017, 17(1): 163.
13. Öztürk E, Kafalı HC, Tanıdır İC, et al. Early postoperative arrhythmias in patients undergoing congenital heart surgery. Turk Gogus Kalp Damar Cerrahisi Derg, 2021, 29(1): 27-35.
14. Eikelboom R, Sanjanwala R, Le ML, et al. Postoperative atrial fibrillation after cardiac surgery: A systematic review and meta-analysis. Ann Thorac Surg, 2021, 111(2): 544-554.
15. Boons J, Van Biesen S, Fivez T, et al. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery: A narrative review. J Cardiothorac Vasc Anesth, 2021, 35(11): 3394-3403.
16. Phan K, Khuong JN, Xu J, et al. Obesity and postoperative atrial fibrillation in patients undergoing cardiac surgery: Systematic review and meta-analysis. Int J Cardiol, 2016, 217: 49-57.
17. Vural Ü, Ağlar AA. What is the role of metabolic syndrome and obesity for postoperative atrial fibrillation after coronary bypass grafting? BMC Cardiovasc Disord, 2019, 19(1): 147.
18. Jain A, Alam S, Viralam SK, et al. Incidence, risk factors, and outcome of cardiac arrhythmia postcardiac surgery in children. Heart Views, 2019, 20(2): 47-52.
19. Turkkolu ST, Selçuk E, Köksal C. Biochemical predictors of postoperative atrial fibrillation following cardiac surgery. BMC Cardiovasc Disord, 2021, 21(1): 167.
20. Chen SC, Chung FP, Chao TF, et al. A link between bilirubin levels and atrial fibrillation recurrence after catheter ablation. J Chin Med Assoc, 2019, 82(3): 175-178.
21. Mariscalco G, Biancari F, Zanobini M, et al. Bedside tool for predicting the risk of postoperative atrial fibrillation after cardiac surgery: The POAF score. J Am Heart Assoc, 2014, 3(2): e000752.
22. Zhu Y, Jing W, Lv P, et al. Clinical factors associated with arrhythmia and short-term prognosis following mitral valve repair: A retrospective cohort study. Cardiovasc Diagn Ther, 2022, 12(1): 114-122.
23. Bramer S, van Straten AH, Soliman Hamad MA, et al. New-onset postoperative atrial fibrillation predicts late mortality after mitral valve surgery. Ann Thorac Surg, 2011, 92(6): 2091-2096.
24. Helgadottir S, Sigurdsson MI, Ingvarsdottir IL, et al. Atrial fibrillation following cardiac surgery: Risk analysis and long-term survival. J Cardiothorac Surg, 2012, 7: 87.

Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Risk factors for arrhythmia after robotic cardiac surgery: A retrospective cohort study

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