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Active Clearance Technology: An Effective Drainage System to Prevent Postoperative Atrial Fibrillation
Samuel St-Onge, Philippe Demers, Walid Ben Ali, Ismail Bouhout, Louis Perrault.
Université de Montréal, Montreal, QC, Canada.

OBJECTIVE: Postoperative atrial fibrillation (POAF) is one of the most frequent complications after heart surgery and significantly increases morbidity. An obstructed chest tube, leaving unevacuated blood around the heart and lung, therefore driving inflammation, may be a contributing factor for this complication. The aim of this study is to assess the effectiveness of chest drainage using active tube clearance (ATC) system in reducing the rate of PAOF and evaluate the impact of ATC on retained blood syndrome (RBS).
METHODS: This is a retrospective analysis based on 344 consecutive patients admitted for heart surgery. We compared 158 patients allocated to an ATC chest drainage protocol from June to August 2014 to 186 consecutive controls who were managed with standard chest drainage from August to September 2014. The primary endpoint was new onset of POAF. Secondary endpoint was the occurrence of RBS, a composite including re-exploration for bleeding or tamponade, and interventions for hemothorax, pericardial effusion and pleural effusion.
RESULTS: Patients undergoing ATC chest drainage protocol had an absolute reduction of 39% in their POAF rate compared to those managed with standard drains (20% vs 33%, p = 0.007). After a propensity score matching based on 15 primary endpoint related variables, ATC drainage showed a protective effect on new onset of PAOF with odds ratio (OR) of 0.52: (95% confidence interval (CI), 0.31-0.86; p = 0.010). On the other hand, there was no difference in the RBS rate (6% vs 5%, p=0.722), even after propensity score matching (OR, 1.24; 95% CI, 0.47-3.29; p=0.670).
CONCLUSIONS: The use of an ATC chest drainage protocol effectively reduced POAF but failed to show a protective effect on interventions for RBS.

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