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Preoperative predictors of new-onset prolonged atrial fibrillation after surgical aortic valve replacement

Content Provider	Scilit
Author	D'Alessandro, David A. Axtell, Andrea L. Moonsamy, Philicia Melnitchouk, Serguei Tolis, George Jassar, Arminder S. Villavicencio, Mauricio A. Cameron, Duke E. Sundt, Thoralf M.
Copyright Year	2019
Description	Journal: Journal of Thoracic and Cardiovascular Surgery Patients undergoing surgical aortic valve replacement (SAVR) are at risk of developing prolonged atrial fibrillation (AF) after surgery. Prophylactic interventions such as left atrial appendage amputation (LAAA) and pulmonary vein isolation (PVI) impose cost and operative risk, discouraging routine use. To guide such interventions, we investigated preoperative predictors of AF. A retrospective analysis was performed on patients undergoing SAVR between 2011 and 2017. Patients were excluded if they had a preoperative history of AF or underwent a LAAA or PVI. Baseline characteristics were compared between those who did and did not develop prolonged postoperative AF. Predictors of prolonged AF were identified using multivariable logistic regression. Of 720 patients identified, 170 (25%) developed prolonged (beyond 30 days) AF. Compared with patients who did not develop AF, those who developed prolonged AF were older (70.1 vs 62.4 years, P < .001), had a greater incidence of hypertension (78% vs 61%, P < .001), and were less likely to smoke (16% vs 31%, P < .01). On multivariable regression, older age (odds ratio, 1.05; P < .01) and left atrial enlargement (odds ratio, 1.66; P = .04) were predictors of prolonged AF. In this high-risk cohort, the incidence of prolonged postoperative AF was 40%. Older age and left atrial enlargement identify a stratum of patients at high risk of developing prolonged postoperative AF after SAVR. Multicenter, prospective studies should investigate the value of prophylactic interventions such as LAAA, Cox maze, or PVI in these individuals to obviate the consideration of late anticoagulation.
Related Links	http://www.jtcvs.org/article/S0022522319310086/pdf
Ending Page	1414
Page Count	8
Starting Page	1407
ISSN	00225223
e-ISSN	1097685X
DOI	10.1016/j.jtcvs.2019.04.077
Journal	Journal of Thoracic and Cardiovascular Surgery
Issue Number	4
Volume Number	159
Language	English
Publisher	Elsevier BV
Publisher Date	2019-05-17
Access Restriction	Open
Subject Keyword	Journal: Journal of Thoracic and Cardiovascular Surgery Atrial Fibrillation Surgical Aortic Valve Replacement Cardiac Surgery Left Atrial Enlargement Prolonged Postoperative Atrial Fibrillation
Content Type	Text
Resource Type	Article
Subject	Pulmonary and Respiratory Medicine Surgery Cardiology and Cardiovascular Medicine

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