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Ann Thorac Surg 1998;65:1834-1835
© 1998 The Society of Thoracic Surgeons

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Correspondence

Reply

^a Division of Cardiothoracic Surgery, University of California Irvine Medical Center, Bldg 53, Rt 81, 101 City Dr S, Orange, CA 92668, USA

To the Editor

The letter by Dr Gill raises several good points regarding this article. The patients reported were a consecutive series by a single surgeon at four separate hospitals. Common to this group was the use of a specific protocol [1], and all patients not requiring ventricular assist device support were included. Readmission data regarding hospitals other than the site of operation were also included.

The issue of postoperative atrial fibrillation is an important one. It is generally accepted that the 30% incidence of atrial fibrillation is the result of multiple factors, the dominant one remaining obscure. Many believe the use of magnesium, digitalis, and ß-blockers is responsible for lowering the overall incidence. Still others suggest that perioperative steroid therapy [2] and thyroid hormone administration [3, 4] affect this rarely serious but costly complication.

We also believe that fluid shifts may influence the incidence of atrial fibrillation, and as a result we use diuretics liberally in the early recovery period [1].

Of great importance, however, is the presumptive treatment of patients who are at high risk for atrial fibrillation. As a consequence, patients with sustained sinus tachycardia (>100 beats/min) who cannot receive ß-blockers or in whom frequent (4/min) premature atrial contractions develop receive a loading dose of intravenous procainamide followed by maintenance for 2 weeks. In this way, almost certain development of atrial fibrillation can be avoided in these patients.

Finally, we thought the title "Coronary Artery Bypass Grafting "On-Pump": Role of the Three Day Discharge", did not imply all patients reported were successfully discharged on the third postoperative day. Rather, in our experience, the "role" of this approach applied only to young patients without significant preoperative morbidity.

References

1. Ott R.A., Moscoso R., Eugene J., et al. Managed care cardiac surgery in the elderly: result of the impact-recovery protocol. Managed Care and the Cardiac Patient. Philadelphia: Hanley & Belfus, 1995.
2. Engelman R.M., Rousou J.A., Flack J.E., III, et al. Fast-track recovery of the coronary bypass patient. Ann Thorac Surg 1994;58:1742-1746.[Abstract]
3. Klemperer J.D., Klein L.I., Ojamaa K., et al. Triiodothyronine therapy lowers the incidence of atrial fibrillation after cardiac operations. Ann Thorac Surg 1996;61:1323-1329.[Abstract/Free Full Text]
4. Ott R.A., Gutfinger D.E., Miller M.P., Alimadadian H., Tanner T.M. Rapid recovery after coronary artery bypass grafting: is the elderly patient eligible?. Ann Thorac Surg 1997;63:634-639.[Abstract/Free Full Text]

This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Services Email this article to a friend Similar articles in this journal Alert me to new issues of the journal Add to Personal Folders Download to citation manager Author home page(s): Richard A. Ott Permission Requests Citing Articles Citing Articles via Google Scholar Google Scholar Articles by Ott, R. A. Search for Related Content PubMed Articles by Ott, R. A.