Atrial Fibrillation, Blood Loss, and Transfusion in Patients With Left Ventricular Dysfunction

Abstract

Despite advancements in surgical technique, intensive care methods and pharmaceutical prophylaxis atrial fibrillation (AF) after on-pump coronary artery bypass remains common. Transfusion, blood loss, and cardiopulmonary bypass (CPB) have been identified as risk factors for AF and adverse outcomes such as early mortality. This study examines outcomes in patients with left ventricular dysfunction after revascularization with and without CPB. A systematic literature review identified 22 studies including 7,454 patients. Meta-analysis through subgroup analysis of the highest-quality studies revealed that the off-pump coronary artery bypass (OPCAB) technique is associated with a significantly lower incidence of blood loss, transfusion requirement, reoperation for bleeding, and length of stay. There was also a reduction in the incidence of AF in the OPCAB group but this was not statistically significant (odds ratio = 0.77, 95% confidence interval 0.58-1.02, p = 0.07). The results strengthen research suggesting that CPB has a damaging effect on hemostasis and subsequent transfusion requirements in this patient group. More research is required to assess the association between OPCAB and AF in patients with ventricular dysfunction.

Off-pump surgery: is it beneficial in patients with left ventricular dysfunction?

“…In their analysis of the STS database, Keeling et al demonstrated that the avoidance of CPB in patients with LVD significantly reduced the risk of postoperative stroke [27]. A recent meta-analysis of 22 observational studies comprising patients with LVD only demonstrated that OPCAB was associated with significantly less blood loss, transfusion and subsequent length of stay [49]. These findings support similar evidence published for low-risk subgroups [50][51][52][53][54][55] and support the theoretical basis that CPB has a deleterious effect on hemostasis through higher levels of systemic heparinization [56], mechanical trauma to blood and platelets [57], capillary leakage due to endothelial damage and activation of complement and coagulation cascades [58].…”