Abstract
3/2007
vol. 4
List do redakcji
Kardiochirurgia i Torakochirurgia Polska 2007; 4 (3): 336
Online publish date: 2007/09/14
STRAŻNICA
TOWARZYSTWO BIBLIJNE I TRAKTATOWE
ZAREJESTROWANY ZWIĄZEK WYZNANIA ŚWIADKÓW JEHOWY W POLSCE 05-830 Nadarzyn, ul. Warszawska 14
tel. 739-16-00, faks 739-17-00
HIA, July 6, 2007
Marian Zembala, MD, PhD
Polish Journal of Cardiothoracic Surgery
Silesian Centre for Heart Disease
Dear Professor Zembala,
It was a real pleasure to attend the 2nd Polish-Ukrainian Cardiac Surgery Congress that took place on June 28-30 this year in Lublin. I appreciated very much the possibility of being there.
While listening to the session entitled Surgical management of rhythm disturbances, I recalled a report from Cleveland on effects of ICU RBC transfusion on incidence of new-onset atrial fibrillation after cardiac surgery.
The authors assumed that RBC transfusion increases the risk of atrial fibrillation in patients undergoing heart operations with cardiopulmonary bypass. The results they obtained permitted them to report: “Red blood cell transfusion in the ICU was identified as a risk factor associated with development of new-onset AF (p<0.0001). Other risk factors included older age, prior history of AF, higher preoperative hematocrit, β-blocker withdrawal, longer aortic clamp time, valve surgery [as some CABGs included also valve procedures], and ICU inotropic usage”. Comparison of the off- and on-pump groups in which CABG was performed revealed a similar odds ratio for RBC transfusion in ICU as a variable (1.22 and 1.25 respectively) [1].
The team suggested that the increased occurrence of AF after RBC transfusion may be due to “augmentation of the inflammatory process.” The CPB and the surgical procedure themselves provoke the inflammatory response, which is further amplified by “direct infusion of inflammatory mediators… It is possible that the temporal confluence of early inflammatory stimuli associated with RBC transfusion in the ICU may result in enhanced leukocyte activation and atrial tissue injury.” (Page 1754.) Interestingly, Bruins et al. described “a biphasic activation of the complement system and release of proinflammatory cytokines after cardiac surgery.” The first phase occurred “in the operating room in response to the blood-bypass circuit exposure.” The second would arrive several days after surgery and was associated with CRP and arrhythmias [2]. On the other hand, steroid administration in...
Pełna treść artykułu...
TOWARZYSTWO BIBLIJNE I TRAKTATOWE
ZAREJESTROWANY ZWIĄZEK WYZNANIA ŚWIADKÓW JEHOWY W POLSCE 05-830 Nadarzyn, ul. Warszawska 14
tel. 739-16-00, faks 739-17-00
HIA, July 6, 2007
Marian Zembala, MD, PhD
Polish Journal of Cardiothoracic Surgery
Silesian Centre for Heart Disease
Dear Professor Zembala,
It was a real pleasure to attend the 2nd Polish-Ukrainian Cardiac Surgery Congress that took place on June 28-30 this year in Lublin. I appreciated very much the possibility of being there.
While listening to the session entitled Surgical management of rhythm disturbances, I recalled a report from Cleveland on effects of ICU RBC transfusion on incidence of new-onset atrial fibrillation after cardiac surgery.
The authors assumed that RBC transfusion increases the risk of atrial fibrillation in patients undergoing heart operations with cardiopulmonary bypass. The results they obtained permitted them to report: “Red blood cell transfusion in the ICU was identified as a risk factor associated with development of new-onset AF (p<0.0001). Other risk factors included older age, prior history of AF, higher preoperative hematocrit, β-blocker withdrawal, longer aortic clamp time, valve surgery [as some CABGs included also valve procedures], and ICU inotropic usage”. Comparison of the off- and on-pump groups in which CABG was performed revealed a similar odds ratio for RBC transfusion in ICU as a variable (1.22 and 1.25 respectively) [1].
The team suggested that the increased occurrence of AF after RBC transfusion may be due to “augmentation of the inflammatory process.” The CPB and the surgical procedure themselves provoke the inflammatory response, which is further amplified by “direct infusion of inflammatory mediators… It is possible that the temporal confluence of early inflammatory stimuli associated with RBC transfusion in the ICU may result in enhanced leukocyte activation and atrial tissue injury.” (Page 1754.) Interestingly, Bruins et al. described “a biphasic activation of the complement system and release of proinflammatory cytokines after cardiac surgery.” The first phase occurred “in the operating room in response to the blood-bypass circuit exposure.” The second would arrive several days after surgery and was associated with CRP and arrhythmias [2]. On the other hand, steroid administration in...
Pełna treść artykułu...
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