Comparison of Two Central Venous Pressure Control Strategies to Prevent Atrial Fibrillation After Coronary Artery Bypass Grafting

Costa, Mario Augusto Cray da; Lirani, Wesley; Wippich, Ana Caroline; Lopes, Luana; Tolentino, Eduardo de Souza; Zampar, Beatriz; Schafranski, Marcelo Derbli

doi:10.5935/abc.20170044

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Original Articles, Cardiac Surgery - Adults • Arq. Bras. Cardiol. 108 (4) • Apr 2017 • https://doi.org/10.5935/abc.20170044 copy

Comparison of Two Central Venous Pressure Control Strategies to Prevent Atrial Fibrillation After Coronary Artery Bypass Grafting

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background:

Atrial fibrillation (AF) takes place in 10-40% of patients undergoing coronary artery bypass grafting (CABG), and increases cardiovascular mortality. Enlargement of atrial chambers is associated with increased AF incidence, so patients with higher central venous pressure (CVP) are expected to have larger atrial distension, which increases AF incidence.

Objective:

To compare post-CABG AF incidence, following two CVP control strategies.

Methods:

Interventional, randomized, controlled clinical study. The sample comprised 140 patients undergoing CABG between 2011 and 2015. They were randomized into two groups, G15 and G20, with CVP maintained ≤ 15 cmH₂O and ≤ 20 cmH₂O, respectively.

Results:

70 patients were included in each group. The AF incidence in G15 was 8.57%, and in G20, 22.86%, with absolute risk reduction of 14.28%, and number needed to treat (NNT) of 7 (p = 0.03). Mortality (G15 = 5.71%; G20 = 11.42%; p = 0.07), hospital length of stay (G15 = 7.14 days; G20 = 8.21 days; p = 0.36), number of grafts (median: G15 = 3, G2 = 2; p = 0.22) and cardiopulmonary bypass use (G15 = 67.10%; G20 = 55.70%; p = 0.22) were statistically similar. Age (p = 0.04) and hospital length of stay (p = 0.001) were significantly higher in patients who developed AF in both groups.

Conclusion:

Keeping CVP low in the first 72 post-CABG hours reduces the relative risk of AF, and may be useful to prevent AF after CABG.

Keywords:
Central Venous Pressure; Atrial Fibrillation/prevention; Myocardial Revascularization; Postoperative Care

Variables	G15 (n = 70)	G20 (n = 70)	p
Age, mean (CV)	60 (0.17)	63 (0.15)	0.6 ^† (†) Mann-Whitney test (two-tailed); CVP: central venous pressure; CV: coefficient of variation.
Male sex, n (%)	47 (67.1)	57 (81.43)	0.07^* *()** Fisher exact test (two-tailed);

Variables	G15 (n = 70)	G20 (n = 70)	p
Diabetes mellitus, n (%)	18 (25.71)	25 (35.71)	0.07^* *()** Fisher exact test (two-tailed);
COPD, n (%)	10 (14.28)	11 (15.71)	1.00^* *()** Fisher exact test (two-tailed);
Peripheral arterial disease, n (%)	7 (10.00)	12 (17.14)	0.27^* *()** Fisher exact test (two-tailed);
Previous recent AMI, n (%)	28 (40)	23 (32.85)	0.48^* *()** Fisher exact test (two-tailed);
LVD (EF < 50%), n (%)	8 (11.42)	16 (22.85)	0.11^* *()** Fisher exact test (two-tailed);
Renal function (GFR), mL/min (CV)	85.78 (0.37)	88.32 (0.49)	0.48 ^† (†) Mann-Whitney test (two-tailed); CVP: central venous pressure; COPD: chronic obstructive pulmonary disease; AMI: acute myocardial infarction; LVD: left ventricular dysfunction; EF: ejection fraction; CV: coefficient of variation; GFR: glomerular filtration rate.

Variables	G15 (n = 70)	G20 (n = 70)	p
Atrial fibrillation, n (%)	6 (8.57)	16 (22.86)	0.03^* *()** Fisher exact test (two-tailed);
In-hospital death, n (%)	4 (5.71)	8 (11.42)	0.07^* *()** Fisher exact test (two-tailed);
Hospital length of stay, mean, days (CV)	7.14 (0.70)	8.21 (0.68)	0.36^† (†) Mann-Whitney test (two-tailed); CVP: central venous pressure; CV: coefficient of variation.
Grafts, median	3	2	0.22 ^† (†) Mann-Whitney test (two-tailed); CVP: central venous pressure; CV: coefficient of variation.
Cardiopulmonary bypass, n (%)	47 (67.10)	39 (55.70)	0.22^* *()** Fisher exact test (two-tailed);

Variables	With AF (n = 22; 15.17%)	Without AF (n = 118; 84.29%)	p
Age, mean (CV)	65.68 (0.15)	60.73 (0.16)	0.04
In-hospital death, n (%)	2 (5.71%)	10 (11.42%)	1.00^* *()** Fisher exact test (two-tailed);
Hospital length of stay, mean, days (CV)	10.22 (0.70)	7.20 (0.67)	0.001^† (†) Mann-Whitney test (two-tailed); CV: coefficient of variation.
Grafts, median	2	2	0.69^† (†) Mann-Whitney test (two-tailed); CV: coefficient of variation.
Cardiopulmonary bypass, n (%)	12 (54.55)	74 (62.71)	0.48^* *()** Fisher exact test (two-tailed);

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