TY - JOUR
T1 - Pericardial Blood as a Trigger for Postoperative Atrial Fibrillation After Cardiac Surgery
AU - St-Onge, Samuel
AU - Perrault, Louis P.
AU - Demers, Philippe
AU - Boyle, Edward M.
AU - Gillinov, A. Marc
AU - Cox, James
AU - Melby, Spencer
N1 - Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/1
Y1 - 2018/1
N2 - Background Prevention strategies have long been sought to reduce the incidence and burden of postoperative atrial fibrillation (POAF) after heart surgery. However, none has emerged as a dominant and widely applicable prophylactic measure. The purpose of this review is to consider the biological mechanisms by which shed mediastinal blood leads to oxidation and inflammation within the postoperative pericardial environment and how this might trigger POAF in susceptible persons, as well as how it could represent a new target for prevention of POAF. Methods We conducted a structured research of literature using PubMed and MEDLINE databases to May 2016. Biomolecular and clinical articles focused on assessing the contribution of pericardial blood, or the resulting inflammation within the pericardial space and its potential role in triggering POAF, were included in this review. Results Evidence suggests that shed mediastinal blood through breakdown products, activation of coagulation cascade, and oxidative burst contributes to a highly pro-oxidant and proinflammatory milieu found within the pericardial space that can trigger postoperative atrial fibrillation in susceptible persons. The extent of this reaction could be blunted by reducing the exposition of pericardium to blood either through posterior pericardiotomy or improved chest drainage. Conclusions Shed mediastinal blood undergoing transformation within the pericardium appears to be an important contributing factor to POAF. Strategies to prevent shed mediastinal blood from pooling around the heart might be considered in developing future paradigms for prevention of POAF.
AB - Background Prevention strategies have long been sought to reduce the incidence and burden of postoperative atrial fibrillation (POAF) after heart surgery. However, none has emerged as a dominant and widely applicable prophylactic measure. The purpose of this review is to consider the biological mechanisms by which shed mediastinal blood leads to oxidation and inflammation within the postoperative pericardial environment and how this might trigger POAF in susceptible persons, as well as how it could represent a new target for prevention of POAF. Methods We conducted a structured research of literature using PubMed and MEDLINE databases to May 2016. Biomolecular and clinical articles focused on assessing the contribution of pericardial blood, or the resulting inflammation within the pericardial space and its potential role in triggering POAF, were included in this review. Results Evidence suggests that shed mediastinal blood through breakdown products, activation of coagulation cascade, and oxidative burst contributes to a highly pro-oxidant and proinflammatory milieu found within the pericardial space that can trigger postoperative atrial fibrillation in susceptible persons. The extent of this reaction could be blunted by reducing the exposition of pericardium to blood either through posterior pericardiotomy or improved chest drainage. Conclusions Shed mediastinal blood undergoing transformation within the pericardium appears to be an important contributing factor to POAF. Strategies to prevent shed mediastinal blood from pooling around the heart might be considered in developing future paradigms for prevention of POAF.
UR - http://www.scopus.com/inward/record.url?scp=85035093417&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2017.07.045
DO - 10.1016/j.athoracsur.2017.07.045
M3 - Review article
C2 - 29174782
AN - SCOPUS:85035093417
SN - 0003-4975
VL - 105
SP - 321
EP - 328
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 1
ER -