Relationship between blood transfusion and increased risk of atrial fibrillation after coronary artery bypass graft surgery

New-onset atrial fibrillation [AF] after cardiac surgery contributes to increased morbidity, hospital length of stay, and resource utilization. Although many aspects of AF after cardiac surgery have already been elucidated, the mechanism by which cardiac surgery predisposes patients to AF has hitherto remained unknown. Recent evidence supports the notion that blood transfusion enhances the inflammatory response, thereby increasing the incidence of post-operative AF. This retrospective study was conducted on 2095 patients who underwent coronary artery bypass grafting [CABG] alone or accompanied by valve surgery between January 2005 and July 2007. Variables associated with the development of new-onset AF were identified using logistic regression. Intensive care unit blood transfusion increased the risk of AF [odds ratio per unit transfused, 1.16; 95% confidence limits, 1.14, 1.24; P<0.001]. Blood transfusion was performed in 487 patients and was associated with a significant increase in new-onset of AF [45.9% vs. 37.9%; P < 0.01]. Homologous blood transfusion can increase the incidence of new-onset AF after CABG. This factor should be considered in identifying patients who might benefit from prophylaxis in order to prevent this common post-operative complication and the adverse consequences thereof

Postoperative mortality and morbidity in elderly patients undergoing coronary artery bypass graft surgery

Elderly patients [>75 years] have constituted the fastest growing portion of the coronary artery bypass grafting [CABG] patient population over the last two decades. Of the goals that surgical care for the elderly pursues, cure may be an unfeasible one; nevertheless, palliation and comfort warrant sufficient importance. The present study sought to examine the postoperative course and events in elderly patients undergoing CABG with or without other procedures and to compare the results with those in younger patients. Demographic, mortality, morbidity, and resource utilization data were collected from the records of the patients undergoing CABG between January 2005 and July 2007 in Imam Khomeini Medical Center, Tehran, Iran. The mean time to extubation was 9.3 and 6.3 hours in the elderly and non-elderly patients, respectively [p < 0.01]. Blood transfusion was required in 87.8% of the elderly compared to 58.5% of the non-elderly subjects [p < 0.01]. The mean Intensive Care Unit stay was 2.1 days for the elderly and 1.4 days for the non-elderly patients [p < 0.001]. In-hospital mortality was 9% for the elderly patients vs. 2.8% for the younger group [p < 0.001]. The elderly patients undergoing CABG had a significantly higher morbidity rate, with an increased incidence of postoperative renal failure, neurological complications, and in-hospital mortality