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Cited by 124Atrial Fibrillation Management and OutcomesCardiac Valve Diseases and TreatmentsCardiac Health and Mental Health

Prognostic implications of preoperative atrial fibrillation in patients undergoing aortic valve replacement: is there an argument for concomitant arrhythmia surgery?

Ngaage, Dumbor L., Schaff, Hartzell V., Barnes, Sunni A., Sundt, Thoralf M., Mullany, Charles J., Dearani, Joseph A., Daly, Richard C., Orszulak, Thomas A.·2006·The Annals of Thoracic Surgery
DOI 10.1016/j.athoracsur.2006.04.004
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Abstract

Background The prognostic significance of preoperative atrial fibrillation (AF) at the time of aortic valve replacement is unknown, as is the potential role for concomitant arrhythmia surgery.Methods We performed a cohort comparison of patients with preoperative AF (n = 129) and preoperative sinus rhythm (SR, n = 252) undergoing aortic valve surgery between 1993 and 2002; patients were matched for age, gender, and left ventricular ejection fraction. Follow-up (mean interval, 4.5 years) was 98% complete. Primary endpoints were late cardiac and all-cause mortality, as well as major adverse cardiac or cerebrovascular event.Results Patients with preoperative AF presented with more severe congestive heart failure (p = 0.03) and more often had significant tricuspid regurgitation (p = 0.01) preoperatively. They also had worse late survival (risk ratio [RR] for death = 1.5, p = 0.03) with 1-, 5-, and 7-year survival rates substantially reduced at 94%, 87%, and 50%, respectively, for those in AF versus 98%, 90%, and 61% for patients in sinus rhythm preoperatively. Individuals in AF had a greater probability of subsequent rhythm-related intervention (RR = 4.7, p = 0.0002), and more frequently developed congestive heart failure (25% vs 10%, p = 0.005) and stroke (16% vs 5%, p = 0.005). By multivariable analysis, preoperative AF was an independent predictor of late adverse cardiac and cerebrovascular events, but not late death.Conclusions Performance of concomitant arrhythmia surgery in patients undergoing aortic valve surgery may reduce late morbidity; however, its potential impact on late mortality in this high-risk subset of patients remains unclear.

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  • AF worsens prognosis in patients with severe valvular heart disease, including those undergoing surgery or transcatheter interventions for aortic or mitral valve disease.

    “AF worsens prognosis in patients with severe valvular heart disease, 256 including those undergoing surgery or transcatheter interventions for aortic or mitral valve disease.”

    From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [258]

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Authors
Ngaage, D. L., Schaff, H. V., Barnes, S. A., Sundt, T. M., Mullany, C. J., Dearani, J. A., Daly, R. C., & Orszulak, T. A.
Affiliations
Mayo Clinic (US)
Corresponding author
Ngaage, Dumbor L.
ORCID
Venue
The Annals of Thoracic Surgery
Publisher
Elsevier BV
Published
2006-10
Volume
82
Issue
4
Pages
1392-1399
ISSN
0003-4975 (ISSN-L)
DOI
10.1016/j.athoracsur.2006.04.004
OpenAlex
W2026377484
Cited by
124
References
21
Citations by year
2025: 2 · 2024: 8 · 2023: 6 · 2022: 2 · 2021: 11 · 2020: 5 · 2019: 3 · 2018: 3 · 2017: 5 · 2016: 8 · 2015: 6 · 2014: 11 · 2013: 10 · 2012: 12
FWCI
4.71
Type
journal article
Language
en
Open access
closed
Licence
Locations
  • The Annals of Thoracic Surgery (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
  • Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Health and Mental Health
Keywords
preoperative atrial fibrillation, aortic valve replacement, sinus rhythm, late mortality, congestive heart failure, stroke, tricuspid regurgitation, prognosis, major adverse cardiac and cerebrovascular events
MeSH terms
Aged, Aged, 80 and over, Algorithms, Aortic Valve, Atrial Fibrillation, Female, Heart Failure, Heart Valve Diseases, Humans, Male, Middle Aged, Postoperative Complications, Prognosis, Risk Factors, Time Factors, Comorbidity, Survival Analysis, Treatment Outcome, Catheter Ablation, Patient Selection, Heart Valve Prosthesis Implantation

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