Introduction Atrial fibrillation (AF) is frequent after any cardiac
surgery, but evidence suggests it may have no significant impact on
survival if sinus rhythm (SR) is effectively restored early after the
onset of the arrhythmia. In contrast, management of preoperative AF is
often overlooked during or after cardiac surgery despite several
proposed protocols. This study sought to evaluate the impact of
preoperative AF on mortality in patients undergoing isolated surgical
aortic valve replacement (AVR). Methods We performed a retrospective,
single-centre study involving 2,628 consecutive patients undergoing
elective, primary isolated surgical AVR from 2008 to 2018. A total of
268/ 2,628 patients (10.1%) exhibited AF before surgery. The effect of
preoperative AF on mortality was evaluated with univariate and
multivariate analyses. Results Short-term mortality was 0.8% and was
not different between preoperative AF and SR cohorts. Preoperative AF
was highly predictive of long-term mortality (median follow-up of 4
years [Q1-Q3 2-7]; HR: 2.24, 95% CI: 1.79-2.79, P<0.001),
and remained strongly and independently predictive after adjustment for
other risk factors (HR: 1.54, 95% CI: 1.21-1.96, P<0.001)
compared with preoperative SR. In propensity score-matched analysis, the
adjusted mortality risk was higher in the AF cohort (OR: 1.47, 95% CI:
1.04-1.99, P=0.03) compared with the SR cohort. Conclusions Preoperative
AF was independently predictive of long-term mortality in patients
undergoing isolated surgical AVR. It remains to be seen whether
concomitant surgery or other preoperative measures to correct AF may
impact long-term survival.
PREOPERATIVE ANEMIA AND INTRAOPERATIVE TRANSFUSION TOGETHER PREDICT WORSENED SHORT AND LONG-TERM MORTALITY AFTER ISOLATED SURGICAL AORTIC VALVE REPLACEMENT