Kun Hua’s research while affiliated with Capital Medical University and other places

Background Combined valve and coronary surgery is a commonly performed surgical technique for treating coexisting valvular and coronary artery disease. This study aims to investigate the effect of reducing the duration of cardiopulmonary bypass by utilizing the off-pump coronary artery bypass grafting (OPCABG) technique on the short-term prognosis of patients. Methods In this retrospective cohort study, 884 patients were divided into groups undergoing OPCABG or on-pump CABG combined with valve surgery based on the CABG technique. We evaluated the relationship between the surgical technique and operative mortality, postoperative atrial fibrillation (POAF), stroke, acute kidney failure (AKI), and perioperative myocardial infarction. Propensity score matching and inverse probability weighting (IPTW) were employed to mitigate differences in baseline characteristics between the two groups. Results The incidence of POAF and AKI were lower in the OPCABG group after IPTW (POAF: 29.5% vs. 39.5%, p = 0.016; AKI: 14.5% vs. 21.2%, p = 0.047). OPCABG technique was independently associated with the POAF (adjusted OR: 0.63, 95% CI: 0.44–0.91, p = 0.014) and AKI (adjusted OR: 0.63, 95% CI: 0.39–0.98, p = 0.049). These results remained even following PSM and IPTW analyses. Conclusion The OPCABG technique is associated with reduced occurrences of POAF and AKI in patients undergoing valve and concomitant coronary surgery and can be safely used.

Postoperative atrial fibrillation (POAF) is a common complication after coronary artery bypass grafting (CABG) surgery. Gut microbiota and its metabolites have been implicated in the development of AF. However, whether the gut–host metabolic interaction contributes to POAF is still unknown. This study aimed to investigate the POAF-associated gut microbiota metabolism biomarkers and related risk model. The POAF ( N = 30) patients and non-POAF ( N = 60) patients from the discovery cohort exhibited significantly different microbiome and metabolome profiles. The differentiated features were mainly implicated in the bile acids (BAs) and short-chain fatty acids metabolism, inflammation, and oxidative stress. Random forest analysis identified the combination of five secondary BAs showed a powerful performance on predicting POAF in the discovery cohort, highlighting significant values of area under the curve (AUC = 0.954) and correct classification rate (CCR, 93.3%). In addition, the five secondary BAs-based risk model also exhibited good performance in differentiating the POAF ( N = 114) and non-POAF individuals ( N = 253) in an independent validation cohort (AUC = 0.872; CCR = 90.4%). This work revealed perturbed microbial and metabolic traits in POAF, providing potential avenues for the prediction and prevention of POAF after CABG.

Background Postoperative atrial fibrillation (POAF) is a frequent complication of heart surgery, prolonging hospital stays, as well as increasing morbidity and mortality rates. While previous studies have investigated the determinants influencing atrial fibrillation (AF) following heart surgery, the specific risk factors contributing to POAF occurrence after coronary artery bypass graft surgery (CABG) are not well understood. Here we used the human magnetic Luminex assay to assess whether biomarkers, particularly cytokines, within intraoperative pericardial fluid could serve as predictive markers for POAF onset among CABG individuals. Methods In this study we identified 180 patients who underwent CABG with no atrial arrhythmia history. The human magnetic Luminex assay was used to quantify the levels of 36 cytokines in pericardial fluid samples collected during the surgery. The occurrence of POAF was continuously monitored, using both postoperative electrocardiograms and telemetry strips, until the time of discharge. Results In our cohort of 124 patients, POAF was observed in 30 patients, accounting for 24.19% of the study population. These patients exhibited significantly higher levels of interleukin (IL)-12p70 in their intraoperative pericardial fluids compared to those with normal sinus rhythms (SR, p < 0.001). Subsequently, IL-12p70 was found to be an independent risk factor for POAF, and receiver operating characteristic (ROC) analysis established a cut-off threshold for predicting POAF onset of 116.435 pg/mL, based on the maximum Youden index (area under the curve: 0.816). Conclusions this study establishes a significant association between elevated IL-12p70 levels in intraoperative pericardial fluid and the risk of POAF, particularly when IL-12p70 concentrations exceed the identified cut-off value of 116.435 pg/mL. These findings suggest that IL-12p70 levels could potentially be utilized as a predictive biomarker for the onset of POAF in patients undergoing CABG. This marker may aid in the early identification and management of patients at heightened risk for this complication.

OBJECTIVES This study aims to investigate the relationship between serum calcium levels and the incidence of postoperative atrial fibrillation in patients undergoing coronary artery bypass graft surgery. METHODS This retrospective, observational cohort study consecutively enrolled patients undergoing isolated coronary artery bypass grafting in Beijing Anzhen hospital from January 2018 to December 2021. Patients with a previous history of atrial fibrillation or atrial flutter or requiring concomitant cardiac surgery were excluded. A logistic regression model was used to determine predictors of postoperative atrial fibrillation. Multivariable adjustment, inverse probability of treatment weighting, and propensity score matching were used to adjust for confounders. Moreover, we conducted univariable and multivariable logistic regression analyses on preoperative and postoperative serum calcium and ionized serum calcium levels. RESULTS The analysis encompassed 12,293 patients. The postoperative atrial fibrillation rate was significantly higher in patients with low serum calcium level than those without (1379 [33.9%] versus 2375 [28.9%], P < 0.001). Low serum calcium level was associated with an increased odds ratio of postoperative atrial fibrillation (odds ratio [95% CI]: 1.27 [1.18–1.37], P < 0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased postoperative atrial fibrillation rate in low serum calcium level group still existed among subgroup analysis based on different age, sex, body mass index, hypertension, hyperlipidemia, CHA2DS2-VASc and magnesium. CONCLUSIONS Low serum calcium level indicates elevated postoperative atrial fibrillation risk in patients undergoing isolated coronary artery bypass graft surgery even after the adjustment for age, sex, cardiovascular risk factors, echocardiographic parameters and laboratory markers.

Background Postoperative atrial fibrillation (POAF) has long been associated with poor perioperative outcomes after coronary artery bypass grafting (CABG). In this study, we aimed to investigate the effect of prolonged POAF durations on perioperative outcomes of CABG. Methods This retrospective cohort study examined CABG patients enrolled at Beijing Anzhen Hospital from January 2018 to September 2021. We compared patients with POAF durations ≥48 hours to patients with POAF durations <48 hours. Primary outcomes were in-hospital mortality, stroke, acute respiratory failure (ARF), acute kidney injury (AKI), and significant gastrointestinal bleeding (GIB); secondary outcomes were postoperative length of stay (LOS) and intensive care unit (ICU) duration. Associations between primary outcomes and POAF duration were determined using logistic regression and restricted cubic spline analyses. Differences in baseline characteristics were controlled using propensity score matching (PSM) and inverse probability of treatment weighting (IPTW). Results Out of 11,848 CABG patients, 3604 (30.4%) had POAF, while 1131 (31.4%) had it for a duration of ≥48 hours. ARF (adjusted odds ratio [OR]: 2.96, 95% confidence interval [CI]: 1.47–6.09), AKI (adjusted OR: 2.37, 95% CI: 1.42–3.99), and significant GIB (adjusted OR: 2.60, 95% CI: 1.38–5.03) were associated with POAF durations ≥48 hours; however, neither in-hospital mortality (adjusted OR: 1.60, 95% CI: 0.97–2.65) nor stroke (adjusted OR: 1.28, 95% CI: 0.71–2.34) was. These results remained even following PSM and IPTW analyses. Conclusions POAF durations longer than 48 hours were independently associated with poorer perioperative recovery from CABG, with respect to the occurrence of ARF, AKI, and GIB, as well as a longer postoperative LOS and ICU duration. However, it was not associated with greater in-hospital mortality or stroke occurrence. All these findings suggest that postoperative monitoring of POAF and positive intervention after detection may be more helpful in optimizing post-CABG patient outcomes.

Background The visceral-adiposity-tissue index (VATI) and the triglyceride-glucose (TyG) index were found to be correlated with an increased risk of cardiovascular events. However, data concerning the association between the visceral adiposity/TyG indexes and the complication of new-onset postoperative atrial fibrillation (POAF), especially in patients who had just undergone off-pump coronary artery bypass grafting (OPCABG), are rare. We explored the predictive value of the computed-tomography-based VATI and the TyG index on new-onset POAF after OPCABG. Methods This study used longitudinal data from the cohort of 542 participants who underwent OPCABG in Beijing Anzhen Hospital since June 2017. The predictive relevance of the VATI and TyG index were evaluated through Cox proportional hazards models and receiver operating characteristic (ROC) curves. The dose‒response relationship of the VATI and TyG index with new-onset POAF was analyzed by multiple-adjusted spline regression models, and sensitivity analysis was used to explore the stability of our findings. Results The analysis found that the highest tertile of VATI [hazard ratio (HR) 2.58, 95% confidence interval (CI) 1.12–3.45; p = 0.01] and TyG index (HR 2.88, 95% CI 1.76–4.71; p = 0.01) were significantly associated with new-onset POAF compared to the lowest tertile after full adjustment for age, sex, body mass index, c-reactive protein levels, diabetes, emergency operation, New York Heart Association (NYHA) III–IV, and left atrial diameter. The area under the ROC curve (AUC) was 0.897 (p < 0.001) and 0.878 (p < 0.001) for the VATI and TyG index, respectively. In addition, the multiple-adjusted spline regression models showed a nonlinear relationship between new-onset POAF and VATI and TyG index (p for nonlinearity <0.001). Sensitivity analyses confirmed that the results were similar for most tertiles. Conclusions The VATI and TyG index were significantly associated with an increased risk for the development of new-onset POAF after OPCABG. Clinical Trial Registration NCT03729531, https://beta.clinicaltrials.gov/study/NCT03729531.