Abstract 15617: Atrial Fibrillation Prevalence, Anticoagulation Practices, and Long-term Outcomes for Patients Discharged With Atrial Fibrillation After Tavr: Results From the Partner 2a and S3i Trials

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
Michael I Brener ◽  
Susheel K Kodali ◽  
Tamim Nazif ◽  
Zixuan Zhang ◽  
Ioanna Kosmidou ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Long Term Outcomes ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Risk ◽  
Risk Patients ◽  
Short And Long Term

Background: Atrial fibrillation (AF) is associated with worse outcomes, including increased mortality, in patients undergoing transcatheter and surgical aortic valve replacement (TAVR/SAVR). Objective: To assess: (i) the short- and long-term prevalence of AF in intermediate surgical risk patients undergoing TAVR and SAVR; (ii) determine rates of anticoagulation (AC) prescription in patients with AF; and (iii) evaluate differences in outcomes. Methods: A total of 2663 patients from the PARTNER 2A and S3i trials were categorized into 3 groups by their baseline and discharge rhythm (sinus rhythm [SR] vs. AF): SR/SR, SR/AF, and AF/AF. Patients were followed for up to two years. Results: Table 1 presents the frequency of AF, AC prescription, and outcomes at 30-days, 1-year, and 2-year follow-up. SR/AF TAVR and SAVR patients continued to manifest relatively high rates of AF at each follow-up point. SR/AF patients were prescribed AC less often than AF/AF patients. For TAVR patients, the development of and discharge in AF was associated with increased bleeding (OR 1.59, 95% CI 1.11-2.26, p=0.01, SR/AF vs. AF/AF) and mortality (OR 1.77, 95% CI 1.04-3.00, p=0.03, SR/AF vs. AF/AF), but not stroke. There were no significant differences in outcomes in the SAVR patients. Conclusion: TAVR/SAVR patients who developed and were discharged in AF (SR/AF) were often in AF at 30 days, 1 year, and 2 year follow-up. While anticoagulation rates were lower in the SR/AF vs. the AF/AF group, bleeding and mortality, but not stroke, rates were higher for TAVR SR/AF vs. AF/AF patients. Further analyses of the associations between AF development, anticoagulation use, and outcomes in TAVR and SAVR patients are warranted.

scholarly journals Indications and predictors for pacemaker implantation after isolated aortic valve replacement with bioprostheses: the CAREAVR study

2020 ◽  
Vol 31 (3) ◽  
pp. 398-404
Author(s):  
Samuli J Salmi ◽  
Tuomo Nieminen ◽  
Juha Hartikainen ◽  
Fausto Biancari ◽  
Joonas Lehto ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Atrioventricular Block ◽  
Sick Sinus Syndrome ◽  
Pacemaker Implantation ◽  
Left Ventricular Ejection ◽  
Surgical Aortic Valve Replacement

Abstract OBJECTIVES We sought to study the indications, long-term occurrence, and predictors of permanent pacemaker implantation (PPI) after isolated surgical aortic valve replacement with bioprostheses. METHODS The CAREAVR study included 704 patients (385 females, 54.7%) without a preoperative PPI (mean ± standard deviation age 75 ± 7 years) undergoing isolated surgical aortic valve replacement at 4 Finnish hospitals between 2002 and 2014. Data were extracted from electronic patient records. RESULTS The follow-up was median 4.7 years (range 1 day to 12.3 years). Altogether 56 patients received PPI postoperatively, with the median 507 days from the operation (range 6 days to 10.0 years). The PPI indications were atrioventricular block (31 patients, 55%) and sick sinus syndrome (21 patients, 37.5%). For 4 patients, the PPI indication remained unknown. A competing risks regression analysis (Fine–Gray method), adjusted with age, sex, diabetes, coronary artery disease, preoperative atrial fibrillation (AF), left ventricular ejection fraction, New York Heart Association class, AF at discharge and urgency of operation, was used to assess risk factors for PPI. Only AF at discharge (subdistribution hazard ratio 4.34, 95% confidence interval 2.34–8.03) was a predictor for a PPI. CONCLUSIONS Though atrioventricular block is the major indication for PPI after surgical aortic valve replacement, >30% of PPIs are implanted due to sick sinus syndrome during both short-term follow-up and long-term follow-up. Postoperative AF versus sinus rhythm conveys >4-fold risk of PPI. Clinical trial registration clinicaltrials.gov Identifier: NCT02626871

scholarly journals Transcatheter or Surgical Aortic Valve Replacement for Low Surgical Risk Patients

2019 ◽  
Vol 12 (14) ◽  
pp. 1399-1401 ◽  
Author(s):  
Islam Y. Elgendy ◽  
Ahmed N. Mahmoud ◽  
Mohamed M. Gad ◽  
Ayman Elbadawi ◽  
Fernando Rivero ◽  
...  
Keyword(s):  
Aortic Valve ◽  
Aortic Valve Replacement ◽  
Valve Replacement ◽  
Surgical Aortic Valve Replacement ◽  
Surgical Risk ◽  
Risk Patients
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