Getting ahead of postoperative complications is a surgeon’s goal, and two papers offering insight on postop atrial fibrillation and infective endocarditis were shared at the “When Patients Fall Off the Pathway” session.
The use of intra-operative AF inducibility can be an effective screening tool to identify a population of patients at increased risk of developing postoperative AF, according to the results of a study performed by Terrence Pong, MD, of Stanford University and his colleagues. A focus of their study was to determine if intra-operative inducibility of AF can be used as a tool to guide preventative therapy in the post-operative period to reduce rates of AF occurence.
Between March 2017 and October, 2018, Dr. Pong and his colleagues treated patients undergoing first time, elective, open heart revascularization and valve surgeries requiring cardiopulmonary bypass at Stanford Hospital, with rapid atrial pacing just prior to initiation of cardiopulmonary bypass in an attempt to induce AF.
Patients who were not inducible to AF were treated with standard postoperative care. The patients in whom AF was induced intra-operatively were then randomized to prophylactic amiodarone vs no additional treatment and followed postoperatively to see if prophylactic treatment decreased the incidence of postop AF.
“Intra-operative AF inducibility can be used as an effective screening tool to identify a population of patients at increased risk of developing postop AF who also respond well to prophylactic treatment,” said Dr. Long. “Use of intra-operative AF screening increases the efficacy of amiodarone and reduces rates of POAF in first time patients undergoing heart revascularization of valve surgeries requiring cardiopulmonary bypass,” he concluded.
Infective endocarditis (IE) recurrence is one of the main concerns after valve surgery for active IE. However, there has been no definitive evidence regarding the benefits of post-discharge oral antibiotics administration after completion of intravenous antibiotic therapy, according to Suzuki Kota, MD, and his colleagues.
Dr. Kota presented their study which evaluated the risk factors of IE recurrence and the impact of post-discharge oral antibiotics therapy following intravenous antibiotics.
The researchers analyzed the midterm outcomes of a cohort of patients who underwent valve surgery for definitive left-sided active IE at 14 affiliated hospitals between 2009 and 2017. Slightly over half of the patients were treated with prophylactic oral antibiotic at the time of discharge (group OA), whereas the rest of the patients did not take oral antibiotic (group Non-OA). The primary outcome was all-cause mortality. Secondary outcomes were recurrence of IE and subset analysis about recurrence.
There were no significant differences between the two groups with regard to patient characteristics, including causative microorganisms, the presence of diabetes mellitus (DM), and the use of hemodialysis (HD). There were also no significant differences between the two groups with regard to inflammatory laboratory data at postoperative 1, 2, and 4 weeks.
Between the two groups, the overall survival rates at 1 and 5 years and the rates of freedom from the recurrence of endocarditis at 1 and 5 years postoperatively, were all nonsignificant differences.
“Our study showed that post-discharge oral antibiotic therapy after valve surgery did not affect the recurrence rate of infective endocarditis, except in those patients undergoing chronic hemodialysis,” Dr. Kota concluded.