Samuel St-Onge1, Louis P Perrault1, Philippe Demers2, Edward M Boyle3, A Marc Gillinov4, James Cox5, Spencer Melby5. 1. Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Quebec, Canada. 2. Department of Cardiac Surgery, Montreal Heart Institute, Université de Montréal, Quebec, Canada. Electronic address: philippe.demers@icm-mhi.org. 3. St. Charles Medical Center, Bend, Oregon. 4. Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, Ohio. 5. Department of Thoracic and Cardiovascular Surgery, Washington University, St. Louis, Missouri.
Abstract
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.
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.
Authors: Yvon Baribeau; Benjamin Westbrook; Yanick Baribeau; Simon Maltais; Edward M Boyle; Louis P Perrault Journal: J Cardiothorac Surg Date: 2019-11-08 Impact factor: 1.637
Authors: Constantin Mork; Simon Adrian Amacher; Brigitta Gahl; Luca Koechlin; Jules Miazza; Thibault Schaeffer; Lena Schmuelling; Jens Bremerich; Denis Berdajs; Nadine Cueni; Michael Kühne; Christian Mueller; Stefan Osswald; Oliver Reuthebuch; Ulrich Schurr; Christian Sticherling; Andrea Kopp Lugli; Stephan Marsch; Hans Pargger; Martin Siegemund; Friedrich Eckstein; Alexa Hollinger; David Santer Journal: ESC Heart Fail Date: 2022-04-19