Postoperative Atrial Fibrillation and Retained Blood-associated Complications After Surgical Revascularisation Using Portable Digital Versus Conventional Drainage System: a Large Retrospective Study

Abstract

Objectives Retained blood syndrome (RBS) is a potentially dangerous consequence of ineffective drainage after heart surgery. Active chest tube clearance decreases RBS and postoperative atrial fibrillation (POAF). The present study assessed if a portable digital drainage system confers similar effects on postoperative outcomes. Methods Prospectively collected data from 1042 consecutive patients with sinus rhythm undergoing first-time surgical revascularization using cardiopulmonary bypass were considered and 863 analyzed retrospectively. Patients with conventional drainage were compared to patients with a portable digital drainage device. Propensity adjustment including comorbidities, anti-aggregating and preoperative medication, hematocrit, perisurgical parameters including chest tube placement, was applied for outcome assessment. Results Among conventionally drained patients, 14.8% had interventions for RBS, with 4.9% reexploration for bleeding/tamponade. Portable digital drainage patients had RBS in 5.3% with 1.4% needing reexploration for bleeding/tamponade (p < 0.001 and 0.024, respectively). Propensity-adjusted patients had 37% reduced incidence of POAF from 29.9% (111 out of 371) in conventional to 18.7% (92 out of 492) in the portable digital drainage cohort (p = 0.002). In-hospital mortality was 1.6% (6 out of 371) in conventional versus 0.8% (4 out of 492) in the portable digital drainage cohort (adjusted p = 0.364). Conclusions The portable digital drainage device used was associated with reduced POAF and RBS interventions. Effective chest drainage immediately at termination of surgery is crucial to minimize intrathoracic RBS associated complications.