Table 3_Comparison of postoperative atrial fibrillation after total coronary revascularization via left anterior thoracotomy and conventional median sternotomy coronary artery bypass grafting.docx

Postoperative atrial fibrillation (POAF) is the most common arrhythmia that occurs after coronary artery bypass grafting (CABG), contributing to increased mortality, morbidity, longer hospital stays, and higher healthcare costs. Total coronary revascularization via anterior thoracotomy (TCRAT) has recently emerged as a minimally invasive alternative to the traditional median sternotomy (MS). In this multicenter retrospective cohort study, 424 patients who underwent elective CABG between 1 January 2022 and 31 December 2024 at three centers were analyzed. Of these, 221 patients received TCRAT and 203 underwent MS. To minimize baseline differences, a propensity score matching of 1:1 was performed based on age, sex, left ventricular ejection fraction (LVEF), left atrial diameter, CHA2DS2-VASc score, systolic pulmonary artery pressure, and baseline β-blocker use. POAF was defined as an episode of atrial fibrillation lasting a minimum of 5 min and confirmed by electrocardiography. Independent risk factors were identified using a multivariate logistic regression analysis. The rate of incidence of POAF was 16.7% in the TCRAT group and 25.1% in the MS group (p = 0.045). After matching, a multivariate analysis showed that the traditional surgical approach, MS, was an independent risk factor for POAF [odds ratio (OR), 6.12; 95% confidence interval (CI), 2.48–15.09; p < 0.001]. Advanced age (OR 1.04, p = 0.019), reduced LVEF (OR 0.95, p = 0.019), longer cross-clamp time (OR 1.07, p < 0.001), higher blood transfusion requirements (OR 1.48, p = 0.004), and diabetes (OR 1.91, p = 0.048) were all identified as independent predictors. Despite longer operative and cross-clamp times, TCRAT was associated with a lower incidence of POAF compared with MS.

术后心房颤动（Postoperative atrial fibrillation, POAF）是冠状动脉旁路移植术（Coronary Artery Bypass Grafting, CABG）后最常见的心律失常，可升高患者死亡率、致残风险，延长住院时长并推高医疗成本。近年来，经前外侧胸壁切开术完成全冠状动脉血运重建（Total Coronary Revascularization via Anterior Thoracotomy, TCRAT）作为传统正中胸骨切开术（Median Sternotomy, MS）的微创替代术式，逐渐应用于临床。本项多中心回顾性队列研究纳入了2022年1月1日至2024年12月31日期间，于三家医疗中心接受择期CABG的424例患者进行分析。其中221例接受TCRAT治疗，203例接受MS治疗。为最小化基线特征差异，研究基于年龄、性别、左心室射血分数（Left Ventricular Ejection Fraction, LVEF）、左心房内径、CHA₂DS₂-VASc评分、收缩期肺动脉压及基线β受体阻滞剂使用情况，按照1:1比例实施倾向得分匹配。本研究将持续至少5分钟且经心电图检查确认的心房颤动发作定义为POAF。采用多因素logistic回归分析筛选POAF的独立危险因素。TCRAT组POAF发生率为16.7%，MS组为25.1%（p=0.045）。匹配后多因素分析结果显示，传统手术方式MS是POAF的独立危险因素[比值比（Odds Ratio, OR）=6.12，95%置信区间（Confidence Interval, CI）：2.48~15.09，p<0.001]。高龄（OR=1.04，p=0.019）、左心室射血分数降低（OR=0.95，p=0.019）、主动脉阻断时间延长（OR=1.07，p<0.001）、输血需求增加（OR=1.48，p=0.004）及糖尿病（OR=1.91，p=0.048）均被确定为POAF的独立预测因素。尽管TCRAT的手术时长与主动脉阻断时间更长，但其POAF发生率显著低于MS组。