Thesis (M.Sc.) - Cairo University - Faculty of Medicine - Department of Critical Care Medicine

Postoperative AF leads to significant morbidity and prolongation of hospital stay, and complicates 20% to 40% of surgical procedures requiring cardiopulmonarybypass (CPB).⁽¹⁾ This study aims at measuring The efficacy of plasminogen activator Inhibitor-1 (PAI - 1) as a predictor of postoperative atrial fibrillation after cardiopulmonary bypass (CPB). We enrolled 100 adult patients undergoing elective cardiac surgery requiring CPB and who were in sinus rhythm at the time of surgery. Blood samples were obtained for measurement of plasminogen activator inhibitor - 1 (PAI - 1) in the morning of the operation and immediately after separation from CPB and administration of protamine. Patients who developed postoperative AF (28 patients, 28%) were significantly older (P=0.04), had history of hypertension (P = 0.035), performed graft to right coronary artery (P < 0.001), performed greater number of grafts (P=0.014), subjected to longer time of cardiopulmonary bypass (CPB) (P = 0.032), subjected to postoperative adminstration of epinephrine and dobutamine (P = 0.005), had lower postoperative ejection fraction (P = 0.028), had postoperative myocardial ischemia (P<0.001), had higher serum level of preoperative PAI - 1 (P = 0.0005), higher serum level of postoperative PAI - 1 (P < 0.0001), had larger left atrial diameter > 4 cm (P < 0.0001), had longer length of ICU stay (P = 0.04), and needed postoperative mechanical ventillation P = 0.0026

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