Abstract
Background: There is considerable interest in atrial fibrillation (AF) ablation during cardiac operations, but there are few studies addressing the impact of preoperative AF on late outcome of surgery. We therefore investigated AF prevalence in nonrheumatic mitral regurgitation and its effect on late survival and morbidity after repair. Methods: From 1993 through 2002, 36% of 2,821patients with mitral regurgitation had preexisting AF. A cohort of these was matched with controls in sinus rhythm (SR) for age, gender, and ejection fraction. Follow-up was by questionnaire. Outcomes were compared between 231AF and 229 SR patients, and patients with different types of preoperative AF. Results: Patients with preoperative AF were more symptomatic and frequently had cardiomegaly, heart failure, and higher mean pulmonary artery systolic pressure. Operative mortality was higher for AF patients (2% vs 0, p = 0.05). More AF patients had late adverse cardiac events and stroke (63% vs 31%, p < 0.0001). Five- and ten-year survival was, respectively, 95% and 88% for SR patients compared with 90% and 70% (p = 0.01) for the AF group. By multivariate analysis, preoperative AF was not a predictor of long-term survival but was an independent risk factor for late adverse cardiac events and stroke. Conclusions: Preoperative AF is a marker for increased surgical risk of mitral regurgitation repair, and a risk factor for late adverse cardiac events and stroke. Although the independent contribution of AF to late survival is uncertain, preoperative AF increases postoperative morbidity independently; therefore, corrective intervention would be expected to benefit patients in this regard.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 434-443 |
| Number of pages | 10 |
| Journal | Annals of Thoracic Surgery |
| Volume | 84 |
| Issue number | 2 |
| DOIs | |
| State | Published - Aug 2007 |
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ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
Cite this
Influence of Preoperative Atrial Fibrillation on Late Results of Mitral Repair : Is Concomitant Ablation Justified? / Ngaage, Dumbor L.; Schaff, Hartzell V; Mullany, Charles J.; Barnes, Sunni; Dearani, Joseph A.; Daly, Richard C.; Orszulak, Thomas A.; Sundt, Thoralf M.
In: Annals of Thoracic Surgery, Vol. 84, No. 2, 08.2007, p. 434-443.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Influence of Preoperative Atrial Fibrillation on Late Results of Mitral Repair
T2 - Is Concomitant Ablation Justified?
AU - Ngaage, Dumbor L.
AU - Schaff, Hartzell V
AU - Mullany, Charles J.
AU - Barnes, Sunni
AU - Dearani, Joseph A.
AU - Daly, Richard C.
AU - Orszulak, Thomas A.
AU - Sundt, Thoralf M.
PY - 2007/8
Y1 - 2007/8
N2 - Background: There is considerable interest in atrial fibrillation (AF) ablation during cardiac operations, but there are few studies addressing the impact of preoperative AF on late outcome of surgery. We therefore investigated AF prevalence in nonrheumatic mitral regurgitation and its effect on late survival and morbidity after repair. Methods: From 1993 through 2002, 36% of 2,821patients with mitral regurgitation had preexisting AF. A cohort of these was matched with controls in sinus rhythm (SR) for age, gender, and ejection fraction. Follow-up was by questionnaire. Outcomes were compared between 231AF and 229 SR patients, and patients with different types of preoperative AF. Results: Patients with preoperative AF were more symptomatic and frequently had cardiomegaly, heart failure, and higher mean pulmonary artery systolic pressure. Operative mortality was higher for AF patients (2% vs 0, p = 0.05). More AF patients had late adverse cardiac events and stroke (63% vs 31%, p < 0.0001). Five- and ten-year survival was, respectively, 95% and 88% for SR patients compared with 90% and 70% (p = 0.01) for the AF group. By multivariate analysis, preoperative AF was not a predictor of long-term survival but was an independent risk factor for late adverse cardiac events and stroke. Conclusions: Preoperative AF is a marker for increased surgical risk of mitral regurgitation repair, and a risk factor for late adverse cardiac events and stroke. Although the independent contribution of AF to late survival is uncertain, preoperative AF increases postoperative morbidity independently; therefore, corrective intervention would be expected to benefit patients in this regard.
AB - Background: There is considerable interest in atrial fibrillation (AF) ablation during cardiac operations, but there are few studies addressing the impact of preoperative AF on late outcome of surgery. We therefore investigated AF prevalence in nonrheumatic mitral regurgitation and its effect on late survival and morbidity after repair. Methods: From 1993 through 2002, 36% of 2,821patients with mitral regurgitation had preexisting AF. A cohort of these was matched with controls in sinus rhythm (SR) for age, gender, and ejection fraction. Follow-up was by questionnaire. Outcomes were compared between 231AF and 229 SR patients, and patients with different types of preoperative AF. Results: Patients with preoperative AF were more symptomatic and frequently had cardiomegaly, heart failure, and higher mean pulmonary artery systolic pressure. Operative mortality was higher for AF patients (2% vs 0, p = 0.05). More AF patients had late adverse cardiac events and stroke (63% vs 31%, p < 0.0001). Five- and ten-year survival was, respectively, 95% and 88% for SR patients compared with 90% and 70% (p = 0.01) for the AF group. By multivariate analysis, preoperative AF was not a predictor of long-term survival but was an independent risk factor for late adverse cardiac events and stroke. Conclusions: Preoperative AF is a marker for increased surgical risk of mitral regurgitation repair, and a risk factor for late adverse cardiac events and stroke. Although the independent contribution of AF to late survival is uncertain, preoperative AF increases postoperative morbidity independently; therefore, corrective intervention would be expected to benefit patients in this regard.
UR - http://www.scopus.com/inward/record.url?scp=34447554425&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=34447554425&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2007.04.036
DO - 10.1016/j.athoracsur.2007.04.036
M3 - Article
C2 - 17643612
AN - SCOPUS:34447554425
VL - 84
SP - 434
EP - 443
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 2
ER -