Journal Article

Epicardial placement of human placental membrane allografts in coronary artery bypass graft surgery is associated with reduced postoperative atrial fibrillation: a pilot study for a future multi-center randomized controlled trial

Aslam, Usman, Khalpey, Zain, Chnari, Evangelia, Long, Marc, Kumar, Ujjawal, Hitscherich, Pamela

2024

Overview

Background Post-operative atrial fibrillation (POAF) occurs in up to 40% of patients following coronary artery bypass grafting (CABG) and is associated with a higher risk of stroke and mortality. This study investigates how POAF may be mitigated by epicardial placement of aseptically processed human placental membrane allografts (HPMAs) before pericardial closure in CABG surgery. This study was conducted as a pilot feasibility study to collect preliminary for a forthcoming multi-center randomized controlled trial. Methods This retrospective observational study of patients undergoing CABG surgery excluded patients with pre-operative heart failure, chronic kidney disease, or a history of atrial fibrillation. The “treatment” group ( n  = 24) had three HPMAs placed epicardially following cardiopulmonary bypass decannulation but before partial pericardial approximation and chest closure. The only difference in clinical protocol for the control group ( n  = 54) was that they did not receive HPMA. Results HPMA-treated patients saw a significant, greater than four-fold reduction in POAF incidence compared to controls (35.2–8.3%, p  = 0.0136). Univariate analysis demonstrated that HPMA treatment was associated with an 83% reduction in POAF (OR = 0.17, p  = 0.0248). Multivariable analysis yielded similar results (OR = 0.07, p  = 0.0156) after controlling for other covariates. Overall length of stay (LOS) between groups was similar, but ICU LOS trended lower with HPMA treatment ( p  = 0.0677). Post-operative inotrope and vasopressor requirements were similar among groups. There was no new-onset post-operative heart failure, stroke, or death reported up to thirty days in either group. Conclusions Epicardial HPMA placement can be a simple intervention at the end of CABG surgery that may provide a new approach to reduce post-operative atrial fibrillation by modulating local inflammation, possibly reducing ICU and hospital stay, and ultimately improving patient outcomes.

• Publisher: BioMed Central,BioMed Central Ltd,Springer Nature B.V,BMC
• Subject: Abnormalities / Aged / Allografts / Analysis / Aseptically processed human placental membrane allograft / Atrial Fibrillation - etiology / Atrial Fibrillation - prevention & control / Atrial Fibrillation - surgery / Bypass / Cardiac arrhythmia / Cardiac patients / Cardiac Surgery / Cardiovascular disease / Chronic kidney failure / Congestive heart failure / Coronary artery / Coronary artery bypass / Coronary Artery Bypass - adverse effects / Coronary Artery Bypass - methods / Coronary artery bypass grafting / Coronary vessels / Creatinine / Electrocardiography / Feasibility Studies / Female / Fibrillation / Health aspects / Health services / Heart / Heart diseases / Heart failure / Heart surgery / Homografts / Hospitals / Humans / Inflammation / Kidney diseases / Male / Medical research / Medicine / Medicine & Public Health / Medicine, Experimental / Membranes / Middle Aged / Mortality / Muscle contraction / Pathophysiology / Patients / Pericardium / Pilot Projects / Placenta / Post-operative atrial fibrillation / Postoperative Complications - epidemiology / Postoperative Complications - prevention & control / Pregnancy / Renal failure / Retrospective Studies / Surgeons / Surgery / Thoracic Surgery / Vein & artery diseases