Preoperative atrial fibrillation predicts mortality and morbidity after aortic valve replacement

Wang, Tom Kai Ming; Ramanathan, Tharumenthiran; Choi, David; Gamble, Greg; Ruygrok, Peter

doi:10.1093/icvts/ivu128

Cited by 21 publications

(16 citation statements)

References 23 publications

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“…However, the impact of preoperative paroxysmal AF in these patients is less well known. Namely, earlier studies included only patients with permanent AF or patients with paroxysmal and permanent AF, were pooled . Thus, the prognostic significance of paroxysmal AF has remained elusive.…”

Section: Introductionsupporting

confidence: 92%

“…In AF patients on OAC and suffering from stroke, INR at the time of event was outside the therapeutic target in more than 50% of patients. 23 Permanent AF is a well-known predictor of adverse outcomes in patients scheduled for SAVR (14). However, to our best knowledge there are no earlier studies addressing the question of paroxysmal AF in patients undergoing SAVR with a bioprosthesis.…”

Section: Discussionmentioning

confidence: 99%

“…10 Several studies have demonstrated that preoperative permanent AF is a predictor of impaired outcome after adult cardiac surgery and transcatheter aortic valve implantation (TAVI). 7,8,[10][11][12][13][14][15] However, the impact of preoperative paroxysmal AF in these patients is less well known. Namely, earlier studies included only patients with permanent AF 2,13,16 or patients with paroxysmal and permanent AF, were pooled.…”

mentioning

confidence: 99%

“…Namely, earlier studies included only patients with permanent AF 2,13,16 or patients with paroxysmal and permanent AF, were pooled. 4,14,17 Thus, the prognostic significance of paroxysmal AF has remained elusive.…”

mentioning

confidence: 99%

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Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study

Nissinen

Lehto

Biancari

et al. 2020

Clinical Cardiology

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Background Preoperative permanent atrial fibrillation (AF) is associated with impaired outcome after surgical aortic valve replacement (SAVR). The impact of preoperative paroxysmal AF, however, has remained elusive. Purpose We assessed the impact of preoperative paroxysmal AF on outcome in patients undergoing SAVR with bioprosthesis. Methods A total of 666 patients undergoing isolated AVR with a bioprosthesis were included. Survival data was obtained from the national registry Statistics Finland. Patients were divided into three groups according to the preoperative rhythm: sinus rhythm (n = 502), paroxysmal AF (n = 90), and permanent AF (n = 74). Results Patients in the sinus rhythm and paroxysmal AF groups did not differ with respect to age (P = .484), gender (P = .402) or CHA2DS2‐VASc score (P = .333). At 12‐month follow‐up, AF was present in 6.2% of sinus rhythm patients and in 42.4% of paroxysmal AF patients (P < .001). During follow‐up, incidence of fatal strokes in the paroxysmal AF group was higher compared to sinus rhythm group (1.9 vs 0.4 per 100 patient‐years, HR 4.4 95% Cl 1.8‐11.0, P = .001). Cardiovascular mortality was higher in the paroxysmal AF group than in the sinus rhythm group (5.0 vs 3.0 per 100 patient‐years, HR 1.70 95% CI 1.05‐2.76, P = .03) and equal to patients in the permanent AF (5.0 per 100 patient‐years). Conclusion Patients undergoing SAVR with bioprosthesis and history of paroxysmal AF had higher risk of developing permanent AF, cardiovascular mortality and incidence of fatal strokes compared to patients with preoperative sinus rhythm. Life‐long anticoagulation should be considered in patients with a history of preoperative paroxysmal AF.

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Section: Introductionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

mentioning

confidence: 99%

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Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study

Nissinen

Lehto

Biancari

et al. 2020

Clinical Cardiology

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“…Therefore, aortic stenosis or aortic regurgitation may be a predictor of AF. The presence of AF in patients with aortic valve disease is associated with considerable increase in morbidity and mortality [2,3]. The Cox-maze IV procedure has proved to be a safe and effective way to eliminate AF for patients with preoperative AF associated with valve diseases [4,5].…”

mentioning

confidence: 99%

A Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined With Isolated Aortic Valve Disease

Jiang

Líu

et al. 2016

The Annals of Thoracic Surgery

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Isolated aortic valve diseases can lead to atrial fibrillation (AF) by causing left atrium pressure overload and enlargement. At present, most patients with preoperative AF and isolated aortic valve disease have undergone a Cox-maze IV procedure through a left atriotomy under cardiopulmonary bypass with aortic cross-clamping. Here, we describe a novel modified epicardial radiofrequency ablation procedure performed on a beating heart without aortic cross-clamping or opening the left atrium. This technique has proved to be safe and feasible, with good clinical outcomes. It may be useful in selecting the best ablation approaches for patients with AF and aortic valve disease.

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Lung Transplantation for Chronic Lung Disease: Cardiac Considerations

Wille

Reynolds

Rusanov

2020

Cardiac Considerations in Chronic Lung Disease

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Preoperative atrial fibrillation predicts mortality and morbidity after aortic valve replacement

Abstract: AF was associated with several cardiovascular and cardiac surgery risk factors, but remained independently associated with short- and long-term mortality. AF should be incorporated into cardiac surgery risk models and surgical AF ablation may be considered with AVR.

Cited by 21 publications

References 23 publications

Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study

Preoperative paroxysmal atrial fibrillation predicts high cardiovascular mortality in patients undergoing surgical aortic valve replacement with a bioprosthesis: CAREAVR study

A Modified Epicardial Radiofrequency Ablation for Preoperative Atrial Fibrillation Combined With Isolated Aortic Valve Disease

Lung Transplantation for Chronic Lung Disease: Cardiac Considerations

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