ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Surgery
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1697113
Comparison of Postoperative Atrial Fibrillation After Total Coronary Revascularization via Left Anterior Thoracotomy (TCRAT) and Conventional Median Sternotomy Coronary Artery Bypass Grafting
Provisionally accepted
- 1Department of Cardiology, Faculty of Medicine, Istinye University, Sariyer, Istanbul, Türkiye
- 2SUNY Downstate Health Sciences University, Department of Cardiology, Brooklyn, New York, United States
- 3Department of Cardiology, Hatay Training and Research Hospital, Hatay, Türkiye
- 4Department of Cardiovascular Surgery, Ozel Mersin Yenisehir Hospital, Mersin, Türkiye
- 5Department of Cardiovascular Surgery, Ozel Gaziantep Anka Hospital, Gaziantep, Türkiye
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Postoperative atrial fibrillation (POAF) is the most common arrhythmia after coronary artery bypass grafting (CABG), leading to increased mortality, morbidity, longer hospital stays, and higher healthcare costs. Total Coronary Revascularization via Anterior Thoracotomy (TCRAT) has recently become a minimally invasive alternative to the traditional median sternotomy (MS). In this multicenter retrospective cohort study, 424 patients undergoing elective CABG between January 1, 2022, and December 31, 2024 at three centers were analyzed: 221 received TCRAT, and 203 underwent MS. To minimize baseline differences, 1:1 propensity score matching was performed based on age, sex, left ventricular ejection fraction (LVEF), left atrial (LA) diameter, CHA₂DS₂-VASc score, systolic pulmonary artery pressure (SPAP), and baseline β-blocker use. POAF was defined as an atrial fibrillation episode lasting at least 5 minutes and confirmed by electrocardiography. Independent risk factors were identified through multivariate logistic regression analysis. The incidence of POAF was 16.7% in the TCRAT group and 25.1% in the MS group (p = 0.045). After matching, multivariate analysis showed that the 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 to MS.
Keywords: Coronary Artery Bypass, postoperative atrial fibrillation, Left anterior thoracotomy, TCRAT, mediansternotomy
Received: 01 Sep 2025; Accepted: 13 Oct 2025.
Copyright: © 2025 SURAL, ASLAN, MUTLU, YERAL, ÖZÇALIŞKAN and GÖKASLAN. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Sefa SURAL, drsefasural@yahoo.com
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