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Perioperative risk factors for atrial fibrillation (AF) in patients underwent uniportal video-assisted thoracoscopic (VATS) pneumonectomy versus open thoracotomy: single center experience

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Abstract

Objectives

To evaluate perioperative risk factors for AF in patients undergoing uniportal VATS pneumonectomy versus open thoracotomy, and to investigate mediastinal lymph nodes dissection (MLND) on the occurrence of AF.

Methods

Patients were divided into 2 groups based on the surgical approach: uniportal VATS and open pneumonectomy. Analysis was done using chi-square test. Multiple variables were tested using univariate analysis. A p value ≤ 0.05 was considered statistically significant.

Results

Three-hundred and forty-one patients underwent pneumonectomy between 2014 and 2018 in Shanghai Pulmonary Hospital. Fifty-eight patients underwent uniportal VATS, and 283 underwent thoracotomies. AF was the most common event observed. The overall occurrence of peri-operative AF was 33/341 (9.67%). In the uniportal, converted, and open group the incidence of AF was: 3/52 (5.76%), 1/6 (16.6%), and 29/283 (10.42%), respectively. Overall, there was no specific surgical technique correlated with increased incidence of AF (p = 0.432). By univariate analysis; large tumor size > 4.5 cm (p < 0.010), operative time (OT) > 125 min (p < 0.002), and greater volume of blood loss (p < 0.001) increased the risk of AF. Additionally, patients who experienced higher post-operative pain (p < 0.002) were more vulnerable to developing AF. Mortality occurred in one AF patient (1/33, 3%). Number of lymph nodes harvested was not related to AF incidence (p = 0.520).

Conclusions

Although AF incidence was lower in uniportal group, it was not statistically significant. Large tumor size, long operative time, and increased blood loss were associated with increased risk of perioperative AF. These results need to be confirmed by larger studies.

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Acknowledgements

We acknowledge Dr. Hamzeh Albaba for revising the manuscript.

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Author notes

  1. Junrong Ding and Dr. Samer Al Sawalhi contributed equally.

Authors and Affiliations

  1. Department of Thoracic Surgery, Shanghai Pulmonary Hospital, Tongji University, 507 Zhengmin Road, Shanghai, 200433, China

    Samer Al Sawalhi, Junrong Ding, Jacopo Vannucci, Yuping Li & Deping Zhao

  2. Department of Thoracic Surgery, University of Rome Sapienza, Policlinico Umberto I, Rome, Italy

    Jacopo Vannucci

  3. Department of Surgery, King Faisal University, Al-Ahsa, Saudi Arabia

    Ahmad Odeh

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  1. Samer Al Sawalhi
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  2. Junrong Ding
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  6. Deping Zhao
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Correspondence to Deping Zhao.

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Dr. Samer Al Sawalhi, Dr. Jacopo Vannucci MD, Dr. Yuping Li MD, Dr. Ahmad Odeh MD, Dr. Deping Zhao MD, and Junrong Ding have no conflicts of interest or financial ties to disclose.

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Supplementary file1Video Uniportal VATS left pneumonectomy procedure (MP4 66310 kb)

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Al Sawalhi, S., Ding, J., Vannucci, J. et al. Perioperative risk factors for atrial fibrillation (AF) in patients underwent uniportal video-assisted thoracoscopic (VATS) pneumonectomy versus open thoracotomy: single center experience. Gen Thorac Cardiovasc Surg 69, 487–496 (2021). https://doi.org/10.1007/s11748-020-01491-3

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  • DOI: https://doi.org/10.1007/s11748-020-01491-3

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