Storage time of intraoperative transfused allogeneic red blood cells is not associated with new-onset postoperative atrial fibrillation in cardiac surgery.

Jiwei Gu,Carl-Johan Jakobsen,Regitze Kuhr Skals,Søren Lundbye-Christensen,Mikkel Steen Petersen,John Bæch,Christian Torp-Pedersen,Jan Jesper Andreasen

doi:10.1371/journal.pone.0172726

Abstract

BackgroundAllogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery. Prolonged storage time of RBC may increase the risk. The primary aim of the study was to evaluate whether the storage time of RBC is associated with development of POAF.Materials and methodsPre-, per- and postoperative data were retrieved from the Western Denmark Heart Registry and local blood banks regarding patients who underwent coronary artery bypass surgery, valve surgery or combined procedures in Aalborg or Aarhus University Hospital during 2010–2014. Multiple logistic regression was used to determine the risk of POAF according to transfusion of RBC on the day of surgery. Furthermore, we determined trend in storage time of RBC according to risk of POAF using restricted cubic splines. Patients with a history of preoperative atrial fibrillation, patients who received transfusions preoperative and patients who died at the day of surgery were among excluded patients.ResultsA total of 2,978 patients with a mean age of 66.4 years were included and 609 patients (21%) received RBC transfusion on the day of surgery. POAF developed in 752 patients (25%) and transfused patients were at an increased risk compared with non-transfused patients (adjusted Odds Ratios for patients receiving RBC: 1.37; 95% CI: 1.11–1.69, P-value = 0.004). However, RBC transfusion was not necessarily the cause of POAF and may only be a marker for development of POAF. There was no significant association between storage time of RBC and POAF.ConclusionsIn contrast to intraoperative allogeneic RBC transfusion in general, increased storage time of RBC is not associated with development of POAF in cardiac surgery.

Highlights

Postoperative new-onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery with a reported incidence of approximately 20–60%, depending on definition, type of surgeries and the methods used for identifying the diagnosis [1,2,3].Despite decades of surgical, anaesthetic, and medical advances, rates of postoperative atrial fibrillation (POAF) following cardiac surgery remain largely unchanged
POAF developed in 752 patients (25%) and transfused patients were at an increased risk compared with non-transfused patients
In contrast to intraoperative allogeneic red blood cell (RBC) transfusion in general, increased storage time of RBC is not associated with development of POAF in cardiac surgery

Summary

Introduction

Postoperative new-onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery with a reported incidence of approximately 20–60%, depending on definition, type of surgeries and the methods used for identifying the diagnosis [1,2,3].Despite decades of surgical, anaesthetic, and medical advances, rates of POAF following cardiac surgery remain largely unchanged. Postoperative new-onset atrial fibrillation (POAF) is the most common arrhythmia after cardiac surgery with a reported incidence of approximately 20–60%, depending on definition, type of surgeries and the methods used for identifying the diagnosis [1,2,3]. The pathogenesis of atrial fibrillation including POAF seems to be multifactorial [10,11,12] and allogeneic red blood cell (RBC) transfusion has been associated with development of POAF [13,14]. Allogeneic red blood cell (RBC) transfusion has been associated with new-onset postoperative atrial fibrillation (POAF) following cardiac surgery.

Objectives

Methods

Results

Conclusion