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J Thorac Cardiovasc Surg 2002;123:232-236
© 2002 The American Association for Thoracic Surgery

Cardiopulmonary Support and Physiology (CSP)

Benefits of prophylactic continuous infusion of furosemide after the maze procedure for atrial fibrillation

From the Department of Thoracic and Cardiovascular Surgery^a and the Division of Cardiac Anesthesiology,^b Georgetown University Medical Center, Washington, DC.

Received for publication May 16, 2001. Revisions requested June 26, 2001; revisions received July 16, 2001. Accepted for publication July 23, 2001. Address for reprints: Niv Ad, MD, Cardiothoracic Surgery Department, Hadassah University Hospital, Jerusalem 91120, Israel (E-mail: nivadmd{at}hotmail.com).

Objectives: One of the most significant complications seen after the maze procedure for atrial fibrillation is excessive fluid retention, with subsequent pulmonary complications. To address this problem we recently started treating all patients prophylactically with a continuous infusion of furosemide starting immediately after the operation.
Methods: Seventy-five consecutive patients with statistically similar demographic characteristics were divided into two groups. In the continuous infusion group (n = 36) furosemide was given intravenously as a continuous infusion at a dose of 2 to 15 mg/h for the first 48 hours after the operation, and in the bolus dose group (n = 39) furosemide was administered in bolus doses (50-100 mg) to maintain a targeted daily urinary output of 25 to 50 mL/kg. Hemodynamic data, urinary output, fluid balance, daily weights, and pulmonary complications were recorded during the first 48 hours after the operation.
Results: The mean postoperative urinary output was higher, the total furosemide dose was lower, and the pulmonary complications were fewer in the continuous infusion group than in the bolus dose group. Three patients in the bolus dose group were reintubated after the operation, whereas none in the continuous infusion group were reintubated. Supplemental oxygen requirements were greater in the bolus dose group (7 vs 4 patients, P < .05). In the bolus dose group, 4 patients (10%) required thoracentesis and 3 patients (8%) required chest tube insertions for postoperative pleural effusions, in contrast with 1 patient (3%) each in the continuous infusion group (P < .05).
Conclusion: Despite a smaller total dose relative to bolus infusion, prophylactic continuous furosemide infusion decreased the adverse pulmonary complications associated with excessive fluid retention in patients undergoing the maze procedure for atrial fibrillation.

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