Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes

Abstract

Background Atrial fibrillation after cardiac surgery (AFACS) impacts 10 to 65% of patients. AFACS is associated with stroke and other systemic embolic manifestations. Methods Patients at our hospital who underwent rheumatic valve surgery procedures including aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG were included in this study in the period from 2002 to 2017. Results In total, 346 patients were included in the current analysis, with a mean age of 51.6 ± 16.1 years, and 51% were males. AFACS was documented in 102 patients (29.9%) . Univariate predictors of AFACS included age, gender, body mass index (BMI), operation type, left ventricular ejection fraction (EF), left atrial (LA) diameter, previous history of AF, use of aldosterone antagonists more than a month before surgery, use of diuretics more than a month before surgery, length of ICU stay, total length of stay, cross-clamp time more than 90 minutes, pump time more than 120 minutes, postoperative acute kidney injury, left ventricular dimensions.By multivariate analysis, only age (p = 0.028, AOR = 10.6), male gender (p = 0.021, AOR = 3.4), type of surgery (p = 0.034, AOR = 7.12), history of AF (p = 0.018, AOR = 2.32), BMI (p < 0.001, AOR = 3.91), EF before surgery (p ≤ 0.001, AOR = 3.91), and LA diameter (p = 0.0051, AOR = 18.23) were independent predictors of AFACS. Conclusion This study identifies risk factors associated with the development of atrial fibrillation after rheumatic valve heart surgery. Older patients, male gender, type of surgery, preoperative AF, BMI, EF before surgery, and LA diameter are independent predictors of AF after cardiac valve surgery.

Enlargement of the Left Atrium Strongly Predicts Postoperative Mortality Following Heart Valve Surgery

“…Following CABG, valve surgery is second in terms of frequency of performance as open-heart surgery in Jordan. Our studies results regarding mortality and morbidity after valve operations have been published previously (5)(6)(7). According to these studies, age, emergency valve surgery, EF<35%, use of beta-blockers for more than a month before surgery, use of a tissue valve, type of surgery performed, pump run time, and cross-clamp time were all found to be independent predictors of mortality after valve heart surgery.…”

“…In a previous study on the same cohort, we showed that LA enlargement was associated with postoperative atrial fibrillation. 7 …”

“…According to these studies, age, emergency valve surgery, EF<35%, use of beta-blockers for more than a month before surgery, use of a tissue valve, type of surgery performed, pump run time, and cross-clamp time were all found to be independent predictors of mortality after valve heart surgery. [5][6][7] In practice, one can be considered a preoperative predictor of mortality. Left atrium enlargement has been shown in many clinical situations to be a predictor of morbidity and mortality 8,9 Ferreira et al 8 showed that, in terms of echocardiographic criteria, the increase in left atrium volume was the only determinant associated with a need for mechanical ventricular assist device, heart transplantation and death in patients with dilated cardiomyopathy.…”

“…3 In the northern part of Jordan, we previously identified clinical factors that predict mortality and morbidity following heart valve surgery, including age, use of a biological valve, emergency valve surgery, Ejection Fraction (EF) less than 35%, pump run time, cross-clamp time, use of beta-blockers for less than one month before surgery, and type of surgical procedure performed. [5][6][7] In this study, we investigated the association between an enlarged left atrium and mortality following different types of valve replacement surgery in Jordanian patients.…”

“…In a previous study on the same cohort, we showed that LA enlargement was associated with postoperative atrial fibrillation. 7 It has been suggested that rheumatic heart disease has been eradicated in developed countries due to improved lifestyles and use of antibiotics. 19 However, migration in many developed countries and refugee crises have led to an increase in rheumatic heart disease, a pathology that has not been treated in these areas for a long time.…”