Post-operative atrial fibrillation, intraoperative autologous blood salvage and transfusion in cardiac surgery

BACKGROUND AND OBJECTIVES: Postoperative atrial fibrillation is the most common complication following cardiac surgical procedures. The objective of this study was to assess a possible association of postoperative atrial fibrillation, intraoperative autologous blood salvage, and blood transfusion. METHODS: A total of 357 adult patients undergoing cardiac surgery with the use of intraoperative autologous blood salvage were included. They were divided into two groups: one with 161 patients (45%) who only received their recovered autologous blood, and another with 196 patients (55%) who additionally required the transfusion of homologous blood components. Demographic data, pre- and post-operative laboratory parameters, transfusion profiles, and clinical outcomes (mortality) were compared. RESULTS: The number of recovered autologous blood units was not associated with an increased risk of postoperative arrhythmia (Odds ratio: 0.75; 95% CI: 0.45-1.11). Intraoperative homologous blood transfusion was associated with a significantly increased risk of death (Hazard ratio: 5.17; 95% CI 1.44-18.56). When autologous salvaged blood volume and homologous components were evaluated together, homologous transfusion was associated with higher risk of postoperative atrial fibrillation (Odds ratio: 2.51, 95% CI 1.18-5.65), whereas number of autologous units was not (OR 0.66, 95% CI 0.39-1.01). Transfusion at any time point (intraoperative, intensive care unit [ICU], or ward) was also associated with an increased risk of death (Hazard ratio: 5.15, 95% CI 1.16-22.94). CONCLUSION: While advanced age was significantly associated with postoperative atrial fibrillation, no association was found with intraoperative autologous blood salvage and blood transfusion.