CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 301 were given a 300-mg IV bolus of amiodarone within one hour and continuous 900-mg IV amiodarone over the next 24 hours for maintenance, followed by 200 mg of amiodarone orally three times a day. During the entire AF period, low-molecular-weight heparin was administered (enoxaparin 0.1 mg/kg twice daily). Patients who did not return to sinus rhythm were discharged on oral warfarin therapy. This study complied with the Declaration of Helsinki and was carried out following approval of the Ethics Committee for Clinical Trials of Kocaeli Derince Training and Research Hospital of Health Sciences University (approval number: 2022105). All patients were operated on with median sternotomy under general anaesthesia. Standard CPB was established with aortic and venous cannulations, and systemic heparin (300 IU/kg) was administered, with the maintenance of activated clotting time > 450 seconds. Hyperkalaemic cold blood cardioplegia was applied for cardiac arrest. Surgery was performed under moderate hypothermia (28–30ºC). CPB flow was maintained at 2.2–2.5 l/min/m2, mean perfusion pressure between 50 and 80 mmHg, and haematocrit level between 20 and 25%. After distal anastomoses were made, the aortic cross-clamp was removed and proximal anastomoses were done on the ascending aorta under a lateral clamp on a beating heart. CPB was terminated following stable haemodynamics. Following decannulation, the heparin was neutralised with protamine. All patients were transferred postoperatively to the ICU intubated. They were extubated following the onset of spontaneous breathing and normalisation of orientation and co-operation if the haemodynamic and respiratory functions were appropriate. Statistical analysis IBM SPSS statistics version 22.0 software (SPSS Inc, Chicago, IL) was used for the analysis of data. Descriptive data are presented as number (percentage), mean ± standard deviation, or median (range), where appropriate. Categorical variables were compared using Pearson’s chi-squared test or Fisher’s exact test. Depending on the normality of the data, continuous variables were compared using the Mann–Whitney U- or student’s t-test for independent samples. Among the data measured, the normality of distribution was evaluated by histogram or Kolmogorov–Smirnov test, and the homogeneity of distribution was evaluated by ‘Levene’s test for equality of variance’. The effects of the risk factors suggested to be influential on the early postoperative AF were studies with univariate logistic regression analysis. The multiple effects of the risk factors that were influential, or were suggested to be influential in predicting the early postoperative AF as a result of the univariate statistical analysis were studied through the retrospective selective multivariate logistic regression analysis. The odds ratio, 95% confidence interval (CI) and significance level for each of the risk factors were found statistically significant for p < 0.05. Results The demographic characteristics and clinical data of the patients are summarised in Table 1. There were no differences between the two groups in terms of demographic and clinical data. The pre-operative blood analysis and haematological parameters of the patients are summarised in Table 2. RDW (p = 0.0001), ESR (p= 0.0001) and CRP (p= 0.0001) levels were significantly different between the groups. The early postoperative blood analysis and haematological parameters of the patients are summarised in Table 3. Postoperative first-, third- and seventh-day CRP (p = 0.0001), ESR (p = 0.0001) and RDW (p = 0.0001) levels were significantly different between the groups. Among 790 patients, AF occurred in 183 (23.2%) subjects in the first 72 postoperative hours, and 163 (89.1%) of these returned to normal sinus rhythm with amiodarone therapy. Fourteen patients (7.6%) were discharged following conversion to sinus rhythm with electrical cardioversion; six patients (3.3%), for whom appropriate rate control could not be established, were discharged with AF rhythm and oral anticoagulant (warfarin sodium) therapy. Table 1. Demographic and clinical properties of the patients Patients’ characteristics Group 1 with AF (n = 183) Group 2 without AF (n = 607) p-value Age, years (mean ± SD) 58.2 ± 5.9 58.3 ± 6.3 0.81** Male, n (%) 142 (77.6) 469 (77.3) 0.93* Female, n (%) 41 (22.4) 138 (22.7) Hypertension, n (%) 54 (19.9) 129 (24.9) 0.12* Diabetes mellitus, n (%) 52 (20.2) 131 (24.6) 0.18* Smoking, n (%) 75 (24.3) 108 (22.5) 0.56* Hyperlipidaemia, n (%) 83 (22.9) 100 (23.1) 0.89* BMI (kg/m2) (mean ± SD) 26.5 ± 3.7 26.3 ± 3.5 0.67** Ejection fraction (%) (mean ± SD) 54.8 ± 8.8 55.1 ± 8.9 0.68** Basal heart rate (bpm) (mean ± SD) 65.8 ± 7.4 66.6 ± 7.3 0.18** Left atrial diameter (mm) (mean ± SD) 34.8 ± 3.4 34.5 ± 3.1 0.25** AF: atrial fibrillation, BMI: body mass index. *Pearson’s chi-squared test,**Student’s t-test. Table 2. Pre-operative blood results and haematological parameters of patients Pre-operative blood results and haematological parameters Group 1 with AF (n = 183) Group 2 without AF (n = 607) p-value Mean ± SD Mean ± SD Haemoglobin (mg/dl) 13.6 ± 1.4 13.3 ± 1.5 0.11* Creatinine (mg/dl) 0.73 ± 0.30 0.75 ± 0.29 0.92* Urea (mg/dl) 40.7 ± 3.9 40.6 ± 3.8 0.90* HbA1c (%) 6.2 ± 1.5 6.3 ± 1.4 0.58* Leucocyte counts (× 103 cells/μl) 8.1 ± 1.5 8.2 ± 1.6 0.81* Thrombocyte counts (× 103 cells/μl) 253 ± 60 261 ± 62 0.10* CRP (mg/l) 1.53 ± 0.63 0.63 ± 0.38 0.0001* ESR (mm/h) 12.13 ± 3.41 7.57 ± 3.21 0.0001* RDW (%) 15.40 ± 0.92 13.69 ± 1.09 0.0001* HDL-C (mg/dl) (mmol/l) 35.9 ± 5.9 0.93 ± 0.15 36.7 ± 6.5 0.95 ± 0.17 0.17* LDL-C (mg/dl) (mmol/l) 124.9 ± 18.3 3.23 ± 0.47 126.9 ± 17.5 2.29 ± 0.45 0.21* Total cholesterol (mg/dl) (mmol/l) 189.2 ± 40.7 4.9 ± 1.05 187.2 ± 40.3 4.73 ± 1.04 0.56* Triglycerides (mg/dl) (mmol/l) 155.3 ± 67.5 1.75 ± 0.76 159.4 ± 76.7 1.8 ± 0.87 0.51* AF: atrial fibrillation, HDL-C: high-density lipoprotein cholesterol, LDL-C: low-density lipoprotein cholesterol, HbA1c: glycated haemoglobin, CRP: C-reactive protein, ESR: erythrocyte sedimentation rate, RDW: red blood cell distribution width. *Student’s t-test.
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