Epicardial placement of human placental membrane allografts in coronary artery bypass graft surgery is associated with reduced post-operative atrial fibrillation

Abstract Background Post-operative atrial fibrillation (POAF) occurs in up to 40% of patients following coronary artery bypass grafting (CABG) and is associated with 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. Methods This retrospective observational study of patients undergoing CABG surgery excluded patients with pre-operative heart failure, chronic kidney disease, 1 or a history of atrial fibrillation. The “treatment” group (n = 24) had three HPMAs placed epicardially prior to partial pericardial approximation and chest closure; the control group (n = 54) did not receive HPMA. Results HPMA-treated patients saw a significant, greater than four-fold reduction in POAF incidence compared to controls (35.2% to 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 pressor requirement 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