Analysis of Postoperative Atrial Fibrillation and Its Associated Factors in Morrow Procedures with Cardiopulmonary Bypass

Analysis of Postoperative Atrial Fibrillation and Its Associated Factors in Morrow Procedures with Cardiopulmonary Bypass | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article Analysis of Postoperative Atrial Fibrillation and Its Associated Factors in Morrow Procedures with Cardiopulmonary Bypass Zhibin Hu, Wenshuai Mao, Lijun Guo, Zhiwei Liu, Xujie Hu, Yong Cui This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-5346754/v1 This work is licensed under a CC BY 4.0 License Status: Published Journal Publication published 31 Jan, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted 4 You are reading this latest preprint version Abstract Background The factors influencing the onset of new atrial fibrillation following the Morrow procedure due to cardiopulmonary bypass are unclear. This study investigated the cardiopulmonary bypass (CPB)-related factors associated with postoperative atrial fibrillation (POAF) in patients undergoing minimally invasive ventricular septal myectomy (Morrow procedure) to optimize CPB strategies, reduce the incidence of POAF, and enhance recovery. Methods A retrospective clinical data analysis was conducted on 139 patients who underwent minimally invasive Morrow procedures from January to December 2023. The patients were divided into two groups based on whether they developed new-onset atrial fibrillation after surgery, and a comparative study was performed. Multivariate regression analysis and other statistical methods were used to assess factors potentially influencing POAF during CPB. Results Fifty (35.97%) patients developed POAF. Comparisons between the POAF group and the non-POAF group revealed significant differences in preoperative hypertension (38.0% vs. 14.6%, p = 0.002), coronary artery disease (40.0% vs. 20.2%, p = 0.012), history of heart failure (44.0% vs. 22.5%, p = 0.008), age (55.16 ± 14.11 vs. 46.28 ± 14.55, p = 0.001), the preoperative systemic immune-inflammation index (SII) (418.26 ± 243.97 vs. 330.24 ± 152.89, p = 0.016), the left atrial volume index (LAVI) (36.79 ± 12.08 vs. 32.24 ± 10.78, p = 0.024), CPB time (129.80 ± 39.58 vs. 116.96 ± 28.80, p = 0.035), CPB weaning time (25.68 ± 22.56 vs. 19.49 ± 6.78, p = 0.021), re-CPB rate (14.0% vs. 3.4%, p = 0.020), rate of ultrafast-track cardiac anaesthesia (UFTCA) (78.0% vs. 98.9%, p = 0.000), and postoperative SII (3292.84 ± 2921.82 vs. 2312.09 ± 1584.15, p = 0.024) (P < 0.05). All patients were discharged, but the ICU (2.07 ± 2.91 vs. 1.38 ± 0.78, p = 0.046) and postoperative hospital stays (11.84 ± 7.50 vs. 9.13 ± 2.62, p = 0.002) were significantly prolonged. Age is an independent risk factor for POAF, and the UFTCA is an independent protective factor (p < 0.001). POAF occurrence is closely related to preoperative hypertension (OR = 3.777, 95% CI: 1.599–8.920), a history of heart failure (OR = 2.858, 95% CI: 1.294–6.313), LAVI (OR = 1.035, 95% CI: 1.002–1.069), CPB weaning time (OR = 1.051, 95% CI: 1.001–1.103), re-CPB (OR = 5.035, 95% CI: 1.169–21.840), and postoperative SII (OR = 1.000, 95% CI: 1.000-1.001) (p < 0.05). Conclusion UFTCA is an independent protective factor against POAF. CPB weaning time and re-CPB are risk factors for the occurrence of POAF after the Morrow procedure. Actively implementing UFTCA, shortening the CPB weaning time, and avoiding the re-CPB are expected to lower the risk of POAF, shortening the ICU and hospital stays and enhancing recovery. Atrial fibrillation Cardiopulmonary bypass Thoracoscopic Minimally invasive Systemic immune-inflammation index Background Postoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, with a significant variation in incidence according to surgery type( 1 ). The occurrence of POAF after cardiac surgery is markedly greater than that after noncardiac surgeries, ranging from 15–65%, and can reach as high as 30–65% following valve surgeries( 2 , 3 ). These data, along with those of multiple studies, highlight the critical roles of surgical trauma, cardiopulmonary bypass (CPB), and inflammatory responses in the occurrence of POAF, emphasizing the necessity for an in-depth analysis of these risk factors( 4 , 5 ). Hypertrophic obstructive cardiomyopathy (HOCM) is a condition characterized by abnormal thickening of the left ventricular myocardium, leading to left ventricular outflow tract obstruction. Ventricular septal myectomy (Morrow procedure) is a classic surgical method for treating HOCM that effectively improves blood flow and alleviates patient symptoms. However, the occurrence of POAF in HOCM patients postsurgery may increase the risk of serious consequences such as sudden death( 6 ). In light of this information, we conducted a study focusing on the occurrence of POAF after the minimally invasive Morrow procedure. This study particularly investigated CPB-related factors during surgery, explored their potential connections to the occurrence of POAF and identified key risk factors. Since CPB is a controllable technique, understanding its relationship with the development of POAF is crucial. The findings of this study are reported below. Materials and Methods 1. Definition of POAF The Society of Thoracic Surgeons (STS) defines postoperative atrial fibrillation (POAF) as new atrial fibrillation lasting more than 1 hour and/or requiring treatment( 7 ). 2. Clinical Data This study is a retrospective observational study. The subjects included 154 patients with hypertrophic obstructive cardiomyopathy (HOCM) treated in our department from January 2023 to December 2023. We excluded 10 patients with a history of atrial fibrillation, 2 patients who underwent surgery with hypothermic ventricle fibrillation, and 3 patients who were discharged automatically postsurgery, leaving 139 patients for the final analysis. All patients underwent a modified Morrow procedure through a thoracoscopic-assisted right axillary small incision via the aorta under general anaesthesia with peripheral cardiopulmonary bypass( 8 – 10 ). We meticulously collected preoperative data, including but not limited to age, sex, body surface area (BSA), medical history, comorbidities, and functional indicators of the heart and other vital organs. Intraoperative data included key parameters such as CPB time, aortic cross-clamp (ACC) time, CPB weaning time, volume of fluid input and output, ultrafiltration volume, and total blood transfusion. Postoperative data included electrocardiograms, ICU stay duration, hospital stay duration, pacemaker implantation status, and clinical indicators such as ultrafast track cardiac anaesthesia (UFTCA), cardiac ultrasound, and the immune inflammatory index. Patients were divided into POAF and non-POAF groups based on the occurrence of atrial fibrillation after surgery, followed by detailed comparative analysis. The primary objective of this study was to identify the main influencing factors for the occurrence of POAF, particularly its correlation with the CPB. The secondary objective was to summarize potential adverse clinical outcomes that POAF patients may encounter during hospitalization. This study was approved by the Ethics Committee of our hospital (Approval No. Zhe Ren Yi Lun Shen 2024 Yan Di 244), and informed consent was waived. All the data were obtained from our hospital's electronic medical records system. 3. Statistical analysis Statistical analysis was performed via SPSS version 22.0. Continuous variables are expressed as the means ± standard deviations (‾x ± s), with group comparisons conducted via t tests or analysis of variance for normally distributed variables and nonparametric tests for nonnormally distributed variables. Categorical data are expressed as “numbers (percentages) or medians (quartiles)”, with group comparisons performed via Pearson's χ² test or Fisher's exact test. Univariate and multivariate logistic regression analyses were performed to determine the main influencing factors of POAF. A p value of less than 0.05 was considered statistically significant. Results 1. Echocardiography Results of the Minimally Invasive Morrow Procedure Transthoracic echocardiography revealed that the maximum interventricular septal thickness decreased from 20.28 ± 4.54 mm to 14.65 ± 2.73 mm (95% CI: 4.74–6.51, p < 0.001), and the left ventricular outflow tract (LVOT) pressure gradient decreased from 86.08 ± 41.68 mmHg to 9.58 ± 5.54 mmHg (95% CI: 69.45–83.55, p < 0.001). 2. Overall Incidence of POAF Among the 139 HOCM patients who underwent the minimally invasive Morrow procedure, 50 developed POAF, accounting for 35.97% of the total. 3. Summary of Clinical Data between POAF Patients and Non-POAF Patients 3.1 Preoperative Data There were significant differences between the POAF and non-POAF groups in terms of age, preoperative hypertension, ischaemic cardiomyopathy, history of heart failure, preoperative systemic immune-inflammation index (SII), and left atrial volume index (LAVI) (P 0.05) (Table 1 ). Table 1 Comparison of Preoperative Data between the POAF and Non-POAF Groups POAF(n = 50) N-POAF(n = 89) P value Age(years) 55.16 ± 14.12 46.28 ± 14.55 0.001 Male[n(%)] 20(40.0%) 47(52.8%) 0.147 BSA(m 2 ) 1.82 ± 0.20 1.85 ± 0.18 0.374 Hypertension[n(%)] 19(38.0%) 13(14.6%) 0.002 Diabetes[n(%)] 2(4.0%) 7(7.9%) 0.374 Ischaemic cardiomyopathy[n(%)] 20(40.0%) 18(20.2%) 0.012 Lung disease[n(%)] 10(20.0%) 15(16.9%) 0.643 Smoking[n(%)] 15(30.0%) 20(22.5%) 0.326 History of heart failure[n(%)] 22(44.0%) 20(22.5%) 0.008 EF(%) 68.76 ± 5.12 70.25 ± 4.17 0.065 cTnI(µg/L) 0.154 ± 0.306 0.151 ± 0.358 0.664 BNP(pg/ml) 556.97 ± 653.08 564.04 ± 625.40 0.779 HB(g/L) 137.98 ± 16.74 137.79 ± 18.80 0.952 SII(×109/L) 418.26 ± 243.97 330.24 ± 152.89 0.016 LAVI(ml/m2) 36.79 ± 12.08 32.24 ± 10.78 0.024 EF: Left Ventricular Ejection Fraction; cTnI: Cardiac Troponin I; BNP: B-type Natriuretic Peptide; HB: Haemoglobin; SII: Systemic Immune-Inflammation Index; LAVI: Left Atrial Volume Index. 3.2 Perioperative Data Comparing the POAF group with the non-POAF group, there were significant differences in CPB time, CPB weaning time, rate of re-CPB, and rate of UFTCA (P 0.05) (Table 2 ). Table 2 Comparison of perioperative data between the POAF and non-POAF groups. POAF(n = 50) N-POAF(n = 89) P value CPB time (min) 129.80 ± 39.58 116.96 ± 28.80 0.035 ACC time (min) 81.56 ± 22.57 76.93 ± 23.51 0.150 CPB weaning time (min) 25.68 ± 22.56 19.49 ± 6.78 0.021 rate of re-CPB[n(%)] 7(14.0%) 3(3.4%) 0.020 Ultrafiltration volume (ml) 1730.00 ± 745.39 1824.72 ± 736.44 0.470 Urine volume (ml) 401.00 ± 250.36 394.72 ± 320.97 0.770 NET volume (ml) 103.60 ± 741.81 -51.69 ± 744.50 0.239 blood transfusion [n(%)] 21(42.0%) 25(28.1%) 0.094 UFTCA [n(%)] 39(78.0%) 88(98.9%) 0.000 CPB: Cardiopulmonary Bypass; ACC: Aortic Cross-Clamping. 3.3 Postoperative Adverse Clinical Outcomes Compared with that in the non-POAF group, the postoperative SII in the POAF group was significantly greater (P 0.05). The ICU stay and postoperative hospital stay in the POAF group were significantly longer than those in the non-POAF group (P < 0.05) (Table 3 ). Table 3 Comparison of postoperative indicators and adverse clinical outcomes between the POAF and non-POAF groups. POAF(n = 50) N-POAF(n = 89) P value EF(%) 60.94 ± 6.91 61.70 ± 5.49 0.479 cTnI(µg/L) 15.03 ± 15.56 17.96 ± 18.57 0.629 BNP(pg/ml) 762.33 ± 724.43 788.11 ± 842.13 0.452 HB(g/L) 118.04 ± 16.48 117.76 ± 15.45 0.922 SII(×109/L) 3292.84 ± 2921.82 2312.09 ± 1584.15 0.004 drainage volume 306.80 ± 386.70 261.97 ± 210.51 0.754 ICU stay(d) 2.07 ± 2.91 1.38 ± 0.78 0.046 postoperative hospital stay(d) 11.84 ± 7.50 9.13 ± 2.62 0.002 EF: Left Ventricular Ejection Fraction; cTnI: Cardiac Troponin I; BNP: B-type Natriuretic Peptide; HB: Haemoglobin; SII: Systemic Immune-Inflammation Index; LAVI: Left Atrial Volume Index; ICU: Intensive Care Unit. 4. Multivariate Logistic Regression Analysis Age was found to be an independent risk factor for POAF (p = 0.001, OR = 1.045, 95% CI: 1.107–1.072), whereas UFTCA was identified as an independent protective factor against POAF (p = 0.002, OR = 0.040, 95% CI: 0.005–0.323). The occurrence of POAF was significantly associated with preoperative hypertension (OR = 3.777, 95% CI: 1.599–8.920), a history of heart failure (OR = 2.858, 95% CI: 1.294–6.313), LAVI (OR = 1.035, 95% CI: 1.002–1.069), CPB weaning time (OR = 1.051, 95% CI: 1.001–1.103), re-CPB (OR = 5.035, 95% CI: 1.169–21.840), and the postoperative SII (OR = 1.000, 95% CI: 1.000–1.001) (p < 0.05). Discussion Despite advancements in surgical concepts, perioperative care, and preventive pharmacotherapy, the incidence of postoperative atrial fibrillation (POAF) following cardiac surgery has not decreased significantly over the past few decades( 11 ). The incidence of POAF is lowest after isolated coronary artery bypass grafting (CABG), higher after isolated valve surgery, and highest after combined valve/CABG surgeries, indicating that the type of surgery and the use of CPB play crucial roles in the development of POAF( 12 , 13 ). Hypertrophic obstructive cardiomyopathy (HOCM) is a structural heart disease distinct from coronary artery disease and valvular disease and is characterized by abnormal thickening of the ventricular myocardium, leading to left ventricular outflow tract obstruction. The classical surgical treatment is septal myectomy (Morrow procedure), where a portion of the hypertrophied septal myocardium is resected to relieve left ventricular outflow obstruction. HOCM associated with arrhythmias is a common cause of sudden cardiac death; however, reports on the relationships among the Morrow procedure, CPB, and the development of arrhythmias in the treatment of HOCM are limited. This study focused on patients with HOCM and conducted an in-depth analysis of the CPB-related factors associated with the occurrence of POAF following the Morrow procedure. These findings have important clinical implications for optimizing CPB strategies and reducing the incidence of POAF. This study identified several factors closely associated with the occurrence of POAF, including age, preoperative hypertension, ischaemic cardiomyopathy, history of heart failure, the SII, LAVI, CPB time, CPB weaning time, re-CPB rates, and UFTCA. Notably, UFTCA was confirmed as an independent protective factor against POAF, whereas a longer weaning-off CPB time and re-CPB were identified as CPB-related risk factors. These findings provide clinicians with targeted interventions to reduce the incidence of POAF, potentially shortening patients' ICU and hospital stays and accelerating recovery. The results of this study align with key findings in the literature, which identify older age, hypertension, and a history of heart failure as high-risk factors for POAF( 5 ). Furthermore, this study emphasizes the importance of perioperative management, particularly during CPB, which is consistent with previous research that highlighted the relationship between CPB and POAF( 14 ). However, this study further refined the specific influencing factors during CPB, such as CPB weaning time and re-CPB, providing more precise intervention targets for clinical practice. The CPB weaning time, defined as the period from aortic unclamping to the end of CPB, is a critical phase during which the myocardium may suffer additional ischaemia‒reperfusion injury. The study revealed that longer CPB weaning times were associated with an increased risk of POAF. Although the literature has explored the impact of the CPB time and ACC time on surgical outcomes, studies specifically investigating the CPB weaning time are scarce( 15 – 17 ). Re-CPB refers to the necessity of restarting CPB during cardiac surgery due to bleeding or other reasons. In this study, Re-CPB was significantly associated with the occurrence of POAF, corroborating previous findings that Re-CPB is an independent predictor of postoperative complications( 18 ). Interestingly, the study also revealed that the UFTCA is an independent protective factor against POAF. UFTCA is an advanced anaesthesia management strategy used in cardiac surgery aimed at reducing surgical stress and trauma, facilitating early extubation, and promoting rapid recovery. Several studies have confirmed the benefits of UFTCA combined with minimally invasive techniques in cardiac surgery, including reduced hospital stays, lower complication rates, and improved patient satisfaction( 9 , 19 – 21 ). However, there have been no previous reports on the impact of UFTCA on the incidence of POAF after cardiac surgery or its underlying mechanisms, making this study the first to provide evidence of this association. SII is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. In this study, the SII was significantly correlated with the occurrence of POAF. The increase in the postoperative SII is closely associated with the occurrence of POAF, which aligns with the role of inflammation and oxidative stress in the pathogenesis of POAF( 22 , 23 ). The increased SII may reflect the systemic inflammatory response induced by factors such as CPB, surgical trauma, and re-CPB. Previous studies have addressed this issue. The prolonged CPB weaning time may be linked to exacerbated inflammatory responses. In cardiac surgery, especially during CPB, ischaemia‒reperfusion injury to cardiac tissue can lead to the release of inflammatory mediators. An extended weaning time may increase the accumulation of these inflammatory mediators, thereby increasing the SII. Furthermore, the prolonged CPB weaning time may also reflect the complexity of the surgical process, which can further exacerbate systemic inflammatory responses. Re-CPB itself is a potent trigger for inflammation and oxidative stress. This may lead to further tissue damage and the release of inflammatory mediators, significantly increasing the SII. Additionally, re-CPB may also be related to surgical technique, patient condition, and other complications, all of which may further influence the degree of the inflammatory response. The findings of this study indicate that both CPB weaning time and re-CPB, along with the SII, are factors influencing the occurrence of POAF, indirectly suggesting a certain degree of correlation among these three factors. Limitations of the Study Despite providing valuable insights, this study has several limitations. First, as a retrospective study, it may be subject to selection and information bias. Second, the relatively small sample size could limit the generalizability of the results. Furthermore, the study did not account for all potential factors influencing POAF, such as genetic predisposition, lifestyle, and other potential confounding factors. Finally, this study did not explore the detailed mechanisms by which UFTCA acts as a protective factor, warranting further investigation in future studies. Future Research Directions On the basis of the findings and limitations of this study, future research could focus on the following areas: 1. Prospective multicentre studies: By employing a prospective design and multicentre collaboration, future studies can increase the sample size and improve the generalizability and reliability of the results. 2. Mechanistic Research: Studies can investigate the biological mechanisms through which UFTCA reduces the incidence of POAF, including its potential effects on the inflammatory response and immune regulation. 3. Multifactorial intervention studies: Comprehensive intervention studies can be conducted that target identified risk factors and assess the impact of interventions on POAF incidence. These could include exploring strategies to reduce the CPB weaning time and the re-CPB, as well as their effects on the SII and patient outcomes. Conclusion This study analysed the factors related to POAF following minimally invasive Morrow surgery and suggested potential interventions for reducing the incidence of POAF, such as actively implementing UFTCA, shortening the weaning time of CPB, and avoiding re-CPB. Despite its limitations, this study underscores the importance of optimizing perioperative management and provides directions for future research. With further studies that deepen the understanding of POAF pathogenesis, we hope to more effectively prevent POAF and improve the clinical outcomes of cardiac surgery patients. Declarations Ethics approval and consent to participate This study was approved by the Ethics Committee of Zhejiang Provincial People's Hospital (Approval No. Zhe Ren Yi Lun Shen 2024 Yan Di 244). Written informed consent was waived because of the retrospective nature of the study, and the study was approved by the Ethics Committee of Zhejiang Provincial People's Hospital. Consent for publication All the authors provided their consent for publication in BMC Cardiovascular Disorders. Availability of data and materials The datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request. Competing interests The authors declare that they have no competing interests. Funding The authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the General Research Program in Medicine and Health of Zhejiang Province (2023KY492). Authors' contributions Zhibin Hu; Zhiwei Liu; Wenshuai Mao; Lijun Guo; and Xujie Hu contributed to data curation and writing-original draft preparation. Yong Cui and Zhibin Hu conceived, instructed, reviewed, and revised the manuscript. All the authors read and approved the final manuscript. Corresponding author Correspondence to Yong Cui. 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Systemic immune-inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis. Front Cardiovasc Med. 2024;11:1290610. Mittal S, Bhushan R, Jhajhria N, Aiyer PV, Grover V. The Significance of Systemic Inflammatory Markers in 'New-Onset Atrial Fibrillation' Following Cardiac Surgeries. Cureus. 2024;16(5):e59869. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Published Journal Publication published 31 Jan, 2025 Read the published version in BMC Cardiovascular Disorders → Version 1 posted Editorial decision: Revision requested 30 Oct, 2024 Editor assigned by journal 30 Oct, 2024 Submission checks completed at journal 29 Oct, 2024 First submitted to journal 28 Oct, 2024 You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-5346754","acceptedTermsAndConditions":true,"allowDirectSubmit":false,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":372375844,"identity":"f03dbec8-48d7-4ddb-a5c6-df2101cc23b5","order_by":0,"name":"Zhibin Hu","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Zhibin","middleName":"","lastName":"Hu","suffix":""},{"id":372375847,"identity":"2879cc92-63f4-4006-820d-137af7b15ee0","order_by":1,"name":"Wenshuai Mao","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Wenshuai","middleName":"","lastName":"Mao","suffix":""},{"id":372375848,"identity":"0aad4c85-fd90-4119-9676-c5be1af46bf2","order_by":2,"name":"Lijun Guo","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Lijun","middleName":"","lastName":"Guo","suffix":""},{"id":372375851,"identity":"361c7c84-be98-4d47-8cec-4f24510d0c23","order_by":3,"name":"Zhiwei Liu","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Zhiwei","middleName":"","lastName":"Liu","suffix":""},{"id":372375852,"identity":"912c140f-aa8f-4e96-96ed-ea5de31cffad","order_by":4,"name":"Xujie Hu","email":"","orcid":"","institution":"Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","correspondingAuthor":false,"prefix":"","firstName":"Xujie","middleName":"","lastName":"Hu","suffix":""},{"id":372375853,"identity":"7d7cc1d9-1ffd-44c1-a15e-ffbc1286399e","order_by":5,"name":"Yong Cui","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAAzUlEQVRIiWNgGAWjYBACNmbGxgcfeGzkGPubDxCnhY+9udlwhkyaMfOMYwnEaZHjOd4mzWNzOLG9IceASIdJJDZI8+QwG/M2nPl44w2DnZxuAxFaDOecYZOTbO7dbDmHIdnY7AARWhLe9vAYGzac3SbNw3AgcRsxWg7w/pNI3H8g5xmRWngONjby8BgkNjbksBGphb2xmXEGT4Ix44xjxpZzDIjwi3wz+/MfH3j+g6Ly4Y03FXZyBLWgAAkeIqMGWQupOkbBKBgFo2BEAABpgEP5eslRiwAAAABJRU5ErkJggg==","orcid":"","institution":"Zhejiang Provincial People's Hospital (Affiliated People's Hospital, Hangzhou Medical College)","correspondingAuthor":true,"prefix":"","firstName":"Yong","middleName":"","lastName":"Cui","suffix":""}],"badges":[],"createdAt":"2024-10-28 11:38:18","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-5346754/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-5346754/v1","draftVersion":[],"editorialEvents":[{"content":"https://doi.org/10.1186/s12872-025-04514-0","type":"published","date":"2025-01-31T15:56:53+00:00"}],"editorialNote":"","failedWorkflow":false,"files":[{"id":75351140,"identity":"f5e6a238-f12d-4f45-a7fd-b2a32ae157e1","added_by":"auto","created_at":"2025-02-03 16:04:51","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":519887,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-5346754/v1/c3345310-44dc-4302-8244-f499b07224d7.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"Analysis of Postoperative Atrial Fibrillation and Its Associated Factors in Morrow Procedures with Cardiopulmonary Bypass","fulltext":[{"header":"Background","content":"\u003cp\u003ePostoperative atrial fibrillation (POAF) is a common complication of cardiac surgery, with a significant variation in incidence according to surgery type(\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e). The occurrence of POAF after cardiac surgery is markedly greater than that after noncardiac surgeries, ranging from 15\u0026ndash;65%, and can reach as high as 30\u0026ndash;65% following valve surgeries(\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e, \u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e). These data, along with those of multiple studies, highlight the critical roles of surgical trauma, cardiopulmonary bypass (CPB), and inflammatory responses in the occurrence of POAF, emphasizing the necessity for an in-depth analysis of these risk factors(\u003cspan citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e, \u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Hypertrophic obstructive cardiomyopathy (HOCM) is a condition characterized by abnormal thickening of the left ventricular myocardium, leading to left ventricular outflow tract obstruction. Ventricular septal myectomy (Morrow procedure) is a classic surgical method for treating HOCM that effectively improves blood flow and alleviates patient symptoms. However, the occurrence of POAF in HOCM patients postsurgery may increase the risk of serious consequences such as sudden death(\u003cspan citationid=\"CR6\" class=\"CitationRef\"\u003e6\u003c/span\u003e). In light of this information, we conducted a study focusing on the occurrence of POAF after the minimally invasive Morrow procedure. This study particularly investigated CPB-related factors during surgery, explored their potential connections to the occurrence of POAF and identified key risk factors. Since CPB is a controllable technique, understanding its relationship with the development of POAF is crucial. The findings of this study are reported below.\u003c/p\u003e"},{"header":"Materials and Methods","content":"\u003cp\u003e1. Definition of POAF\u003c/p\u003e \u003cp\u003eThe Society of Thoracic Surgeons (STS) defines postoperative atrial fibrillation (POAF) as new atrial fibrillation lasting more than 1 hour and/or requiring treatment(\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e).\u003c/p\u003e \u003cp\u003e2. Clinical Data\u003c/p\u003e \u003cp\u003eThis study is a retrospective observational study. The subjects included 154 patients with hypertrophic obstructive cardiomyopathy (HOCM) treated in our department from January 2023 to December 2023. We excluded 10 patients with a history of atrial fibrillation, 2 patients who underwent surgery with hypothermic ventricle fibrillation, and 3 patients who were discharged automatically postsurgery, leaving 139 patients for the final analysis. All patients underwent a modified Morrow procedure through a thoracoscopic-assisted right axillary small incision via the aorta under general anaesthesia with peripheral cardiopulmonary bypass(\u003cspan additionalcitationids=\"CR9\" citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e). We meticulously collected preoperative data, including but not limited to age, sex, body surface area (BSA), medical history, comorbidities, and functional indicators of the heart and other vital organs. Intraoperative data included key parameters such as CPB time, aortic cross-clamp (ACC) time, CPB weaning time, volume of fluid input and output, ultrafiltration volume, and total blood transfusion. Postoperative data included electrocardiograms, ICU stay duration, hospital stay duration, pacemaker implantation status, and clinical indicators such as ultrafast track cardiac anaesthesia (UFTCA), cardiac ultrasound, and the immune inflammatory index. Patients were divided into POAF and non-POAF groups based on the occurrence of atrial fibrillation after surgery, followed by detailed comparative analysis. The primary objective of this study was to identify the main influencing factors for the occurrence of POAF, particularly its correlation with the CPB. The secondary objective was to summarize potential adverse clinical outcomes that POAF patients may encounter during hospitalization.\u003c/p\u003e \u003cp\u003eThis study was approved by the Ethics Committee of our hospital (Approval No. Zhe Ren Yi Lun Shen 2024 Yan Di 244), and informed consent was waived. All the data were obtained from our hospital's electronic medical records system.\u003c/p\u003e \u003cp\u003e3. Statistical analysis\u003c/p\u003e \u003cp\u003eStatistical analysis was performed via SPSS version 22.0. Continuous variables are expressed as the means\u0026thinsp;\u0026plusmn;\u0026thinsp;standard deviations (\u0026oline;x\u0026thinsp;\u0026plusmn;\u0026thinsp;s), with group comparisons conducted via t tests or analysis of variance for normally distributed variables and nonparametric tests for nonnormally distributed variables. Categorical data are expressed as \u0026ldquo;numbers (percentages) or medians (quartiles)\u0026rdquo;, with group comparisons performed via Pearson's χ\u0026sup2; test or Fisher's exact test. Univariate and multivariate logistic regression analyses were performed to determine the main influencing factors of POAF. A p value of less than 0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e1. Echocardiography Results of the Minimally Invasive Morrow Procedure\u003c/p\u003e\n\u003cp\u003eTransthoracic echocardiography revealed that the maximum interventricular septal thickness decreased from 20.28\u0026thinsp;\u0026plusmn;\u0026thinsp;4.54 mm to 14.65\u0026thinsp;\u0026plusmn;\u0026thinsp;2.73 mm (95% CI: 4.74\u0026ndash;6.51, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001), and the left ventricular outflow tract (LVOT) pressure gradient decreased from 86.08\u0026thinsp;\u0026plusmn;\u0026thinsp;41.68 mmHg to 9.58\u0026thinsp;\u0026plusmn;\u0026thinsp;5.54 mmHg (95% CI: 69.45\u0026ndash;83.55, p\u0026thinsp;\u0026lt;\u0026thinsp;0.001).\u003c/p\u003e\n\u003cp\u003e2. Overall Incidence of POAF\u003c/p\u003e\n\u003cp\u003eAmong the 139 HOCM patients who underwent the minimally invasive Morrow procedure, 50 developed POAF, accounting for 35.97% of the total.\u003c/p\u003e\n\u003cp\u003e\u003cspan\u003e\u003c/span\u003e\u003c/p\u003e\n\u003cp\u003e3. Summary of Clinical Data between POAF Patients and Non-POAF Patients\u003c/p\u003e\u003cspan\u003e\n \u003cp\u003e3.1 Preoperative Data\u003c/p\u003e\n\u003c/span\u003e\n\u003cp\u003e\u003c/p\u003e\n\u003cp\u003eThere were significant differences between the POAF and non-POAF groups in terms of age, preoperative hypertension, ischaemic cardiomyopathy, history of heart failure, preoperative systemic immune-inflammation index (SII), and left atrial volume index (LAVI) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were found for the other indicators (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab1\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of Preoperative Data between the POAF and Non-POAF Groups\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOAF(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN-POAF(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eP value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eAge(years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e55.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e46.28\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.001\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eMale[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e47(52.8%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.147\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBSA(m\u003csup\u003e2\u003c/sup\u003e)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.82\u0026thinsp;\u0026plusmn;\u0026thinsp;0.20\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1.85\u0026thinsp;\u0026plusmn;\u0026thinsp;0.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHypertension[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19(38.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e13(14.6%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eDiabetes[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e2(4.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(7.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.374\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eIschaemic cardiomyopathy[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(40.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e18(20.2%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.012\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLung disease[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e10(20.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(16.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.643\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSmoking[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e15(30.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.326\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHistory of heart failure[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e22(44.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e20(22.5%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.008\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEF(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e68.76\u0026thinsp;\u0026plusmn;\u0026thinsp;5.12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e70.25\u0026thinsp;\u0026plusmn;\u0026thinsp;4.17\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.065\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecTnI(\u0026micro;g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.154\u0026thinsp;\u0026plusmn;\u0026thinsp;0.306\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e0.151\u0026thinsp;\u0026plusmn;\u0026thinsp;0.358\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.664\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBNP(pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e556.97\u0026thinsp;\u0026plusmn;\u0026thinsp;653.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e564.04\u0026thinsp;\u0026plusmn;\u0026thinsp;625.40\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.779\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHB(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137.98\u0026thinsp;\u0026plusmn;\u0026thinsp;16.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e137.79\u0026thinsp;\u0026plusmn;\u0026thinsp;18.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.952\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSII(\u0026times;109/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e418.26\u0026thinsp;\u0026plusmn;\u0026thinsp;243.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e330.24\u0026thinsp;\u0026plusmn;\u0026thinsp;152.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.016\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eLAVI(ml/m2)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e36.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e32.24\u0026thinsp;\u0026plusmn;\u0026thinsp;10.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.024\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eEF: Left Ventricular Ejection Fraction; cTnI: Cardiac Troponin I; BNP: B-type Natriuretic Peptide; HB: Haemoglobin; SII: Systemic Immune-Inflammation Index; LAVI: Left Atrial Volume Index.\u003c/p\u003e\n\u003cp\u003e3.2 Perioperative Data\u003c/p\u003e\n\u003cp\u003eComparing the POAF group with the non-POAF group, there were significant differences in CPB time, CPB weaning time, rate of re-CPB, and rate of UFTCA (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). No significant differences were observed in the other perioperative indicators (p\u0026thinsp;\u0026gt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e2\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab2\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of perioperative data between the POAF and non-POAF groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOAF(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN-POAF(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCPB time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e129.80\u0026thinsp;\u0026plusmn;\u0026thinsp;39.58\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e116.96\u0026thinsp;\u0026plusmn;\u0026thinsp;28.80\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.035\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eACC time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e81.56\u0026thinsp;\u0026plusmn;\u0026thinsp;22.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e76.93\u0026thinsp;\u0026plusmn;\u0026thinsp;23.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.150\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eCPB weaning time (min)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25.68\u0026thinsp;\u0026plusmn;\u0026thinsp;22.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e19.49\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.021\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003erate of re-CPB[n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e7(14.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e3(3.4%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.020\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUltrafiltration volume (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1730.00\u0026thinsp;\u0026plusmn;\u0026thinsp;745.39\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e1824.72\u0026thinsp;\u0026plusmn;\u0026thinsp;736.44\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.470\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUrine volume (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e401.00\u0026thinsp;\u0026plusmn;\u0026thinsp;250.36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e394.72\u0026thinsp;\u0026plusmn;\u0026thinsp;320.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.770\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eNET volume (ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e103.60\u0026thinsp;\u0026plusmn;\u0026thinsp;741.81\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e-51.69\u0026thinsp;\u0026plusmn;\u0026thinsp;744.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.239\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eblood transfusion [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e21(42.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e25(28.1%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.094\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eUFTCA [n(%)]\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e39(78.0%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003e88(98.9%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.000\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eCPB: Cardiopulmonary Bypass; ACC: Aortic Cross-Clamping.\u003c/p\u003e\n\u003cp\u003e3.3 Postoperative Adverse Clinical Outcomes\u003c/p\u003e\n\u003cp\u003eCompared with that in the non-POAF group, the postoperative SII in the POAF group was significantly greater (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05); no other postoperative indicators were significantly different (P\u0026thinsp;\u0026gt;\u0026thinsp;0.05). The ICU stay and postoperative hospital stay in the POAF group were significantly longer than those in the non-POAF group (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05) (Table \u003cspan class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e\n\u003cdiv class=\"gridtable\"\u003e\u0026nbsp;\u003ctable id=\"Tab3\" border=\"1\"\u003e\n \u003ccaption language=\"En\"\u003e\n \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e\n \u003cdiv class=\"CaptionContent\"\u003e\n \u003cp\u003eComparison of postoperative indicators and adverse clinical outcomes between the POAF and non-POAF groups.\u003c/p\u003e\n \u003c/div\u003e\n \u003c/caption\u003e\n \u003ccolgroup cols=\"4\"\u003e\u003c/colgroup\u003e\n \u003cthead\u003e\n \u003ctr\u003e\n \u003cth align=\"left\"\u003e\u0026nbsp;\u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003ePOAF(n\u0026thinsp;=\u0026thinsp;50)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003eN-POAF(n\u0026thinsp;=\u0026thinsp;89)\u003c/p\u003e\n \u003c/th\u003e\n \u003cth align=\"left\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e value\u003c/p\u003e\n \u003c/th\u003e\n \u003c/tr\u003e\n \u003c/thead\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eEF(%)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e60.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e61.70\u0026thinsp;\u0026plusmn;\u0026thinsp;5.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.479\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003ecTnI(\u0026micro;g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e15.03\u0026thinsp;\u0026plusmn;\u0026thinsp;15.56\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e17.96\u0026thinsp;\u0026plusmn;\u0026thinsp;18.57\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.629\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eBNP(pg/ml)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e762.33\u0026thinsp;\u0026plusmn;\u0026thinsp;724.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e788.11\u0026thinsp;\u0026plusmn;\u0026thinsp;842.13\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.452\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eHB(g/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e118.04\u0026thinsp;\u0026plusmn;\u0026thinsp;16.48\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e117.76\u0026thinsp;\u0026plusmn;\u0026thinsp;15.45\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.922\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eSII(\u0026times;109/L)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e3292.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2921.82\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2312.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1584.15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.004\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003edrainage volume\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e306.80\u0026thinsp;\u0026plusmn;\u0026thinsp;386.70\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e261.97\u0026thinsp;\u0026plusmn;\u0026thinsp;210.51\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.754\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003eICU stay(d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd align=\"left\"\u003e\n \u003cp\u003epostoperative hospital stay(d)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e11.84\u0026thinsp;\u0026plusmn;\u0026thinsp;7.50\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e9.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd align=\"char\"\u003e\n \u003cp\u003e0.002\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n \u003c/table\u003e\n\u003c/div\u003e\n\u003cp\u003eEF: Left Ventricular Ejection Fraction; cTnI: Cardiac Troponin I; BNP: B-type Natriuretic Peptide; HB: Haemoglobin; SII: Systemic Immune-Inflammation Index; LAVI: Left Atrial Volume Index; ICU: Intensive Care Unit.\u003c/p\u003e\n\u003cp\u003e4. Multivariate Logistic Regression Analysis\u003c/p\u003e\n\u003cp\u003eAge was found to be an independent risk factor for POAF (p\u0026thinsp;=\u0026thinsp;0.001, OR\u0026thinsp;=\u0026thinsp;1.045, 95% CI: 1.107\u0026ndash;1.072), whereas UFTCA was identified as an independent protective factor against POAF (p\u0026thinsp;=\u0026thinsp;0.002, OR\u0026thinsp;=\u0026thinsp;0.040, 95% CI: 0.005\u0026ndash;0.323). The occurrence of POAF was significantly associated with preoperative hypertension (OR\u0026thinsp;=\u0026thinsp;3.777, 95% CI: 1.599\u0026ndash;8.920), a history of heart failure (OR\u0026thinsp;=\u0026thinsp;2.858, 95% CI: 1.294\u0026ndash;6.313), LAVI (OR\u0026thinsp;=\u0026thinsp;1.035, 95% CI: 1.002\u0026ndash;1.069), CPB weaning time (OR\u0026thinsp;=\u0026thinsp;1.051, 95% CI: 1.001\u0026ndash;1.103), re-CPB (OR\u0026thinsp;=\u0026thinsp;5.035, 95% CI: 1.169\u0026ndash;21.840), and the postoperative SII (OR\u0026thinsp;=\u0026thinsp;1.000, 95% CI: 1.000\u0026ndash;1.001) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eDespite advancements in surgical concepts, perioperative care, and preventive pharmacotherapy, the incidence of postoperative atrial fibrillation (POAF) following cardiac surgery has not decreased significantly over the past few decades(\u003cspan citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e). The incidence of POAF is lowest after isolated coronary artery bypass grafting (CABG), higher after isolated valve surgery, and highest after combined valve/CABG surgeries, indicating that the type of surgery and the use of CPB play crucial roles in the development of POAF(\u003cspan citationid=\"CR12\" class=\"CitationRef\"\u003e12\u003c/span\u003e, \u003cspan citationid=\"CR13\" class=\"CitationRef\"\u003e13\u003c/span\u003e). Hypertrophic obstructive cardiomyopathy (HOCM) is a structural heart disease distinct from coronary artery disease and valvular disease and is characterized by abnormal thickening of the ventricular myocardium, leading to left ventricular outflow tract obstruction. The classical surgical treatment is septal myectomy (Morrow procedure), where a portion of the hypertrophied septal myocardium is resected to relieve left ventricular outflow obstruction. HOCM associated with arrhythmias is a common cause of sudden cardiac death; however, reports on the relationships among the Morrow procedure, CPB, and the development of arrhythmias in the treatment of HOCM are limited.\u003c/p\u003e \u003cp\u003eThis study focused on patients with HOCM and conducted an in-depth analysis of the CPB-related factors associated with the occurrence of POAF following the Morrow procedure. These findings have important clinical implications for optimizing CPB strategies and reducing the incidence of POAF. This study identified several factors closely associated with the occurrence of POAF, including age, preoperative hypertension, ischaemic cardiomyopathy, history of heart failure, the SII, LAVI, CPB time, CPB weaning time, re-CPB rates, and UFTCA. Notably, UFTCA was confirmed as an independent protective factor against POAF, whereas a longer weaning-off CPB time and re-CPB were identified as CPB-related risk factors. These findings provide clinicians with targeted interventions to reduce the incidence of POAF, potentially shortening patients' ICU and hospital stays and accelerating recovery.\u003c/p\u003e \u003cp\u003eThe results of this study align with key findings in the literature, which identify older age, hypertension, and a history of heart failure as high-risk factors for POAF(\u003cspan citationid=\"CR5\" class=\"CitationRef\"\u003e5\u003c/span\u003e). Furthermore, this study emphasizes the importance of perioperative management, particularly during CPB, which is consistent with previous research that highlighted the relationship between CPB and POAF(\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e). However, this study further refined the specific influencing factors during CPB, such as CPB weaning time and re-CPB, providing more precise intervention targets for clinical practice.\u003c/p\u003e \u003cp\u003eThe CPB weaning time, defined as the period from aortic unclamping to the end of CPB, is a critical phase during which the myocardium may suffer additional ischaemia‒reperfusion injury. The study revealed that longer CPB weaning times were associated with an increased risk of POAF. Although the literature has explored the impact of the CPB time and ACC time on surgical outcomes, studies specifically investigating the CPB weaning time are scarce(\u003cspan additionalcitationids=\"CR16\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR17\" class=\"CitationRef\"\u003e17\u003c/span\u003e).\u003c/p\u003e \u003cp\u003eRe-CPB refers to the necessity of restarting CPB during cardiac surgery due to bleeding or other reasons. In this study, Re-CPB was significantly associated with the occurrence of POAF, corroborating previous findings that Re-CPB is an independent predictor of postoperative complications(\u003cspan citationid=\"CR18\" class=\"CitationRef\"\u003e18\u003c/span\u003e). Interestingly, the study also revealed that the UFTCA is an independent protective factor against POAF. UFTCA is an advanced anaesthesia management strategy used in cardiac surgery aimed at reducing surgical stress and trauma, facilitating early extubation, and promoting rapid recovery. Several studies have confirmed the benefits of UFTCA combined with minimally invasive techniques in cardiac surgery, including reduced hospital stays, lower complication rates, and improved patient satisfaction(\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e, \u003cspan additionalcitationids=\"CR20\" citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e). However, there have been no previous reports on the impact of UFTCA on the incidence of POAF after cardiac surgery or its underlying mechanisms, making this study the first to provide evidence of this association.\u003c/p\u003e \u003cp\u003eSII is an emerging biomarker that provides an integrated measure of inflammation by incorporating neutrophil, lymphocyte, and platelet counts. In this study, the SII was significantly correlated with the occurrence of POAF. The increase in the postoperative SII is closely associated with the occurrence of POAF, which aligns with the role of inflammation and oxidative stress in the pathogenesis of POAF(\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e, \u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e). The increased SII may reflect the systemic inflammatory response induced by factors such as CPB, surgical trauma, and re-CPB. Previous studies have addressed this issue. The prolonged CPB weaning time may be linked to exacerbated inflammatory responses. In cardiac surgery, especially during CPB, ischaemia‒reperfusion injury to cardiac tissue can lead to the release of inflammatory mediators. An extended weaning time may increase the accumulation of these inflammatory mediators, thereby increasing the SII. Furthermore, the prolonged CPB weaning time may also reflect the complexity of the surgical process, which can further exacerbate systemic inflammatory responses. Re-CPB itself is a potent trigger for inflammation and oxidative stress. This may lead to further tissue damage and the release of inflammatory mediators, significantly increasing the SII. Additionally, re-CPB may also be related to surgical technique, patient condition, and other complications, all of which may further influence the degree of the inflammatory response. The findings of this study indicate that both CPB weaning time and re-CPB, along with the SII, are factors influencing the occurrence of POAF, indirectly suggesting a certain degree of correlation among these three factors.\u003c/p\u003e \u003cp\u003eLimitations of the Study\u003c/p\u003e \u003cp\u003eDespite providing valuable insights, this study has several limitations. First, as a retrospective study, it may be subject to selection and information bias. Second, the relatively small sample size could limit the generalizability of the results. Furthermore, the study did not account for all potential factors influencing POAF, such as genetic predisposition, lifestyle, and other potential confounding factors. Finally, this study did not explore the detailed mechanisms by which UFTCA acts as a protective factor, warranting further investigation in future studies.\u003c/p\u003e \u003cp\u003eFuture Research Directions\u003c/p\u003e \u003cp\u003eOn the basis of the findings and limitations of this study, future research could focus on the following areas: 1. Prospective multicentre studies: By employing a prospective design and multicentre collaboration, future studies can increase the sample size and improve the generalizability and reliability of the results. 2. Mechanistic Research: Studies can investigate the biological mechanisms through which UFTCA reduces the incidence of POAF, including its potential effects on the inflammatory response and immune regulation. 3. Multifactorial intervention studies: Comprehensive intervention studies can be conducted that target identified risk factors and assess the impact of interventions on POAF incidence. These could include exploring strategies to reduce the CPB weaning time and the re-CPB, as well as their effects on the SII and patient outcomes.\u003c/p\u003e"},{"header":"Conclusion","content":"\u003cp\u003eThis study analysed the factors related to POAF following minimally invasive Morrow surgery and suggested potential interventions for reducing the incidence of POAF, such as actively implementing UFTCA, shortening the weaning time of CPB, and avoiding re-CPB. Despite its limitations, this study underscores the importance of optimizing perioperative management and provides directions for future research. With further studies that deepen the understanding of POAF pathogenesis, we hope to more effectively prevent POAF and improve the clinical outcomes of cardiac surgery patients.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval and consent to participate\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Ethics Committee of Zhejiang Provincial People\u0026apos;s Hospital (Approval No. Zhe Ren Yi Lun Shen 2024 Yan Di 244). Written informed consent was waived because of the retrospective nature of the study, and the study was approved by the Ethics Committee of Zhejiang Provincial People\u0026apos;s Hospital.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eAll the authors provided their consent for publication in BMC Cardiovascular Disorders.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAvailability of data and materials\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and/or analysed during the current study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors disclosed receipt of the following financial support for the research, authorship, and/or publication of this article: This work was supported by the General Research Program in Medicine and Health of Zhejiang Province (2023KY492).\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthors\u0026apos; contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eZhibin Hu; Zhiwei Liu; Wenshuai Mao; Lijun Guo; and Xujie Hu contributed to data curation and writing-original draft preparation. Yong Cui and Zhibin Hu conceived, instructed, reviewed, and revised the manuscript. All the authors read and approved the final manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCorresponding author\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eCorrespondence to Yong Cui.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors thank Shuwei Wang, Zhiqiang Dong, Xiaofeng Lu, and Chentao Luo for their assistance.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\u003cli\u003e\u003cspan\u003eSkaria R, Parvaneh S, Zhou S, Kim J, Wanjiru S, Devers G, et al. Path to precision: prevention of post-operative atrial fibrillation. J Thorac Dis. 2020;12(5):2735\u0026ndash;46.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eButt JH, Olesen JB, Gundlund A, K\u0026uuml;mler T, Olsen PS, Havers-Borgersen E, et al. Long-term Thromboembolic Risk in Patients With Postoperative Atrial Fibrillation After Left-Sided Heart Valve Surgery. JAMA Cardiol. 2019;4(11):1139\u0026ndash;47.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGudbjartsson T, Helgadottir S, Sigurdsson MI, Taha A, Jeppsson A, Christensen TD, et al. New-onset postoperative atrial fibrillation after heart surgery. Acta Anaesthesiol Scand. 2020;64(2):145\u0026ndash;55.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eSuero OR, Ali AK, Barron LR, Segar MW, Moon MR, Chatterjee S. Postoperative atrial fibrillation (POAF) after cardiac surgery: clinical practice review. J Thorac Dis. 2024;16(2):1503\u0026ndash;20.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eQureshi M, Ahmed A, Massie V, Marshall E, Harky A. Determinants of atrial fibrillation after cardiac surgery. Rev Cardiovasc Med. 2021;22(2):329\u0026ndash;41.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eDesai MY, Bhonsale A, Smedira NG, Naji P, Thamilarasan M, Lytle BW, et al. Predictors of long-term outcomes in symptomatic hypertrophic obstructive cardiomyopathy patients undergoing surgical relief of left ventricular outflow tract obstruction. Circulation. 2013;128(3):209\u0026ndash;16.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMatos JD, McIlvaine S, Grau-Sepulveda M, Jawitz OK, Brennan JM, Khabbaz KR, et al. Anticoagulation and amiodarone for new atrial fibrillation after coronary artery bypass grafting: Prescription patterns and 30-day outcomes in the United States and Canada. J Thorac Cardiovasc Surg. 2021;162(2):616\u0026ndash;e243.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eCui Y, Wang SW, Zhou B, Han EL, Liu ZF, Wu CH, et al. [Minimally invasive right infra-axillary thoracotomy for transaortic modified Morrow procedure: a series of 60 cases]. Zhonghua Wai Ke Za Zhi. 2023;61(3):209\u0026ndash;13.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eJiang S, Wang L, Teng H, Lou X, Wei H, Yan M. The Clinical Application of Ultra-Fast-Track Cardiac Anesthesia in Right-Thoracoscopic Minimally Invasive Cardiac Surgery: A Retrospective Observational Study. J Cardiothorac Vasc Anesth. 2023;37(5):700\u0026ndash;6.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eHu ZB, Mao WS, Guo LJ, Liu ZW, Ge GX, Wang SW, et al. Clinical experience summary of modified del Nido Cardioplegia for videoassisted right subaxillary minimally invasive cardiac surgery. Chin JECC. 2024;22(2):93\u0026ndash;7.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eGaudino M, Di Franco A, Rong LQ, Piccini J, Mack M. Postoperative atrial fibrillation: from mechanisms to treatment. Eur Heart J. 2023;44(12):1020\u0026ndash;39.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAkintoye E, Sellke F, Marchioli R, Tavazzi L, Mozaffarian D. Factors associated with postoperative atrial fibrillation and other adverse events after cardiac surgery. J Thorac Cardiovasc Surg. 2018;155(1):242\u0026ndash;e5110.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eConen D, Wang MK, Devereaux PJ, Whitlock R, McIntyre WF, Healey JS, et al. New-Onset Perioperative Atrial Fibrillation After Coronary Artery Bypass Grafting and Long-Term Risk of Adverse Events: An Analysis From the CORONARY Trial. J Am Heart Assoc. 2021;10(12):e020426.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBoons J, Van Biesen S, Fivez T, de Velde MV, Al Tmimi L. Mechanisms, Prevention, and Treatment of Atrial Fibrillation After Cardiac Surgery: A Narrative Review. J Cardiothorac Vasc Anesth. 2021;35(11):3394\u0026ndash;403.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAuler JOC, editor. editor Extracorporeal Circulation: Prevention and Management of Complications. Anesthesia, Pain, Intensive Care and Emergency Medicine \u0026mdash; APICE; 2000 2000//; Milano: Springer Milan.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eLicker M, Diaper J, Cartier V, Ellenberger C, Cikirikcioglu M, Kalangos A, et al. Clinical review: management of weaning from cardiopulmonary bypass after cardiac surgery. Ann Card Anaesth. 2012;15(3):206\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eAlwaqfi N, AlBarakat MM, Qariouti H, Ibrahim K, Alzoubi N. Stroke after heart valve surgery: a single center institution report. J Cardiothorac Surg. 2024;19(1):518.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eZhou ZE, Sun XS, Xiong XX, Feng J, Chen HY, He LD, et al. Clinical analysis of multiple organ dysfunction syndrome in children after cardiac surgery. Chin JECC. 2013;11(2):71\u0026ndash;4.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerretta P, De Angelis V, Alfonsi J, Pierri MD, Malvindi PG, Zahedi HM, et al. Enhanced recovery after minimally invasive heart valve surgery: Early and midterm outcomes. Int J Cardiol. 2023;370:98\u0026ndash;104.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMaj G, Regesta T, Campanella A, Cavozza C, Parodi G, Audo A. Optimal Management of Patients Treated With Minimally Invasive Cardiac Surgery in the Era of Enhanced Recovery After Surgery and Fast-Track Protocols: A Narrative Review. J Cardiothorac Vasc Anesth. 2022;36(3):766\u0026ndash;75.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eBerretta P, Cefarelli M, Montecchiani L, Alfonsi J, Vessella W, Zahedi MH, et al. Minimally invasive versus standard extracorporeal circulation system in minimally invasive aortic valve surgery: a propensity score-matched study. Eur J Cardiothorac Surg. 2020;57(4):717\u0026ndash;23.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eChen YC, Liu CC, Hsu HC, Hung KC, Chang YJ, Ho CN, et al. Systemic immune-inflammation index for predicting postoperative atrial fibrillation following cardiac surgery: a meta-analysis. Front Cardiovasc Med. 2024;11:1290610.\u003c/span\u003e\u003c/li\u003e \u003cli\u003e\u003cspan\u003eMittal S, Bhushan R, Jhajhria N, Aiyer PV, Grover V. The Significance of Systemic Inflammatory Markers in 'New-Onset Atrial Fibrillation' Following Cardiac Surgeries. Cureus. 2024;16(5):e59869.\u003c/span\u003e\u003c/li\u003e\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":false,"highlight":"","institution":"","isAcceptedByJournal":true,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true},"keywords":"Atrial fibrillation, Cardiopulmonary bypass, Thoracoscopic, Minimally invasive, Systemic immune-inflammation index","lastPublishedDoi":"10.21203/rs.3.rs-5346754/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-5346754/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003ch2\u003eBackground\u003c/h2\u003e \u003cp\u003eThe factors influencing the onset of new atrial fibrillation following the Morrow procedure due to cardiopulmonary bypass are unclear. This study investigated the cardiopulmonary bypass (CPB)-related factors associated with postoperative atrial fibrillation (POAF) in patients undergoing minimally invasive ventricular septal myectomy (Morrow procedure) to optimize CPB strategies, reduce the incidence of POAF, and enhance recovery.\u003c/p\u003e\u003ch2\u003eMethods\u003c/h2\u003e \u003cp\u003eA retrospective clinical data analysis was conducted on 139 patients who underwent minimally invasive Morrow procedures from January to December 2023. The patients were divided into two groups based on whether they developed new-onset atrial fibrillation after surgery, and a comparative study was performed. Multivariate regression analysis and other statistical methods were used to assess factors potentially influencing POAF during CPB.\u003c/p\u003e\u003ch2\u003eResults\u003c/h2\u003e \u003cp\u003eFifty (35.97%) patients developed POAF. Comparisons between the POAF group and the non-POAF group revealed significant differences in preoperative hypertension (38.0% vs. 14.6%, p\u0026thinsp;=\u0026thinsp;0.002), coronary artery disease (40.0% vs. 20.2%, p\u0026thinsp;=\u0026thinsp;0.012), history of heart failure (44.0% vs. 22.5%, p\u0026thinsp;=\u0026thinsp;0.008), age (55.16\u0026thinsp;\u0026plusmn;\u0026thinsp;14.11 vs. 46.28\u0026thinsp;\u0026plusmn;\u0026thinsp;14.55, p\u0026thinsp;=\u0026thinsp;0.001), the preoperative systemic immune-inflammation index (SII) (418.26\u0026thinsp;\u0026plusmn;\u0026thinsp;243.97 vs. 330.24\u0026thinsp;\u0026plusmn;\u0026thinsp;152.89, p\u0026thinsp;=\u0026thinsp;0.016), the left atrial volume index (LAVI) (36.79\u0026thinsp;\u0026plusmn;\u0026thinsp;12.08 vs. 32.24\u0026thinsp;\u0026plusmn;\u0026thinsp;10.78, p\u0026thinsp;=\u0026thinsp;0.024), CPB time (129.80\u0026thinsp;\u0026plusmn;\u0026thinsp;39.58 vs. 116.96\u0026thinsp;\u0026plusmn;\u0026thinsp;28.80, p\u0026thinsp;=\u0026thinsp;0.035), CPB weaning time (25.68\u0026thinsp;\u0026plusmn;\u0026thinsp;22.56 vs. 19.49\u0026thinsp;\u0026plusmn;\u0026thinsp;6.78, p\u0026thinsp;=\u0026thinsp;0.021), re-CPB rate (14.0% vs. 3.4%, p\u0026thinsp;=\u0026thinsp;0.020), rate of ultrafast-track cardiac anaesthesia (UFTCA) (78.0% vs. 98.9%, p\u0026thinsp;=\u0026thinsp;0.000), and postoperative SII (3292.84\u0026thinsp;\u0026plusmn;\u0026thinsp;2921.82 vs. 2312.09\u0026thinsp;\u0026plusmn;\u0026thinsp;1584.15, p\u0026thinsp;=\u0026thinsp;0.024) (P\u0026thinsp;\u0026lt;\u0026thinsp;0.05). All patients were discharged, but the ICU (2.07\u0026thinsp;\u0026plusmn;\u0026thinsp;2.91 vs. 1.38\u0026thinsp;\u0026plusmn;\u0026thinsp;0.78, p\u0026thinsp;=\u0026thinsp;0.046) and postoperative hospital stays (11.84\u0026thinsp;\u0026plusmn;\u0026thinsp;7.50 vs. 9.13\u0026thinsp;\u0026plusmn;\u0026thinsp;2.62, p\u0026thinsp;=\u0026thinsp;0.002) were significantly prolonged. Age is an independent risk factor for POAF, and the UFTCA is an independent protective factor (p\u0026thinsp;\u0026lt;\u0026thinsp;0.001). POAF occurrence is closely related to preoperative hypertension (OR\u0026thinsp;=\u0026thinsp;3.777, 95% CI: 1.599\u0026ndash;8.920), a history of heart failure (OR\u0026thinsp;=\u0026thinsp;2.858, 95% CI: 1.294\u0026ndash;6.313), LAVI (OR\u0026thinsp;=\u0026thinsp;1.035, 95% CI: 1.002\u0026ndash;1.069), CPB weaning time (OR\u0026thinsp;=\u0026thinsp;1.051, 95% CI: 1.001\u0026ndash;1.103), re-CPB (OR\u0026thinsp;=\u0026thinsp;5.035, 95% CI: 1.169\u0026ndash;21.840), and postoperative SII (OR\u0026thinsp;=\u0026thinsp;1.000, 95% CI: 1.000-1.001) (p\u0026thinsp;\u0026lt;\u0026thinsp;0.05).\u003c/p\u003e\u003ch2\u003eConclusion\u003c/h2\u003e \u003cp\u003eUFTCA is an independent protective factor against POAF. CPB weaning time and re-CPB are risk factors for the occurrence of POAF after the Morrow procedure. Actively implementing UFTCA, shortening the CPB weaning time, and avoiding the re-CPB are expected to lower the risk of POAF, shortening the ICU and hospital stays and enhancing recovery.\u003c/p\u003e","manuscriptTitle":"Analysis of Postoperative Atrial Fibrillation and Its Associated Factors in Morrow Procedures with Cardiopulmonary Bypass","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-11-08 21:07:32","doi":"10.21203/rs.3.rs-5346754/v1","editorialEvents":[{"type":"communityComments","content":0},{"type":"decision","content":"Revision requested","date":"2024-10-30T19:11:24+00:00","index":"","fulltext":""},{"type":"editorAssigned","content":"","date":"2024-10-30T18:57:54+00:00","index":"","fulltext":""},{"type":"checksComplete","content":"","date":"2024-10-30T03:09:03+00:00","index":"","fulltext":""},{"type":"submitted","content":"BMC Cardiovascular Disorders","date":"2024-10-28T11:28:20+00:00","index":"","fulltext":""}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"bmc-cardiovascular-disorders","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":false,"externalIdentity":"bcar","sideBox":"Learn more about [BMC Cardiovascular Disorders](http://bmccardiovascdisord.biomedcentral.com/)","snPcode":"","submissionUrl":"https://www.editorialmanager.com/bcar/default.aspx","title":"BMC Cardiovascular Disorders","twitterHandle":"BMC_series","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"em","reportingPortfolio":"BMC Series","inReviewEnabled":true,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"5058f33e-b52b-4562-a966-a6357723d2ff","owner":[],"postedDate":"November 8th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"published-in-journal","subjectAreas":[],"tags":[],"updatedAt":"2025-02-03T15:58:40+00:00","versionOfRecord":{"articleIdentity":"rs-5346754","link":"https://doi.org/10.1186/s12872-025-04514-0","journal":{"identity":"bmc-cardiovascular-disorders","isVorOnly":false,"title":"BMC Cardiovascular Disorders"},"publishedOn":"2025-01-31 15:56:53","publishedOnDateReadable":"January 31st, 2025"},"versionCreatedAt":"2024-11-08 21:07:32","video":"","vorDoi":"10.1186/s12872-025-04514-0","vorDoiUrl":"https://doi.org/10.1186/s12872-025-04514-0","workflowStages":[]},"version":"v1","identity":"rs-5346754","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-5346754","identity":"rs-5346754","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}