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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 1392-1399 |
| Number of pages | 8 |
| Journal | Annals of Thoracic Surgery |
| Volume | 82 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2006 |
Fingerprint
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Surgery
Cite this
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.
In: Annals of Thoracic Surgery, Vol. 82, No. 4, 10.2006, p. 1392-1399.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Prognostic Implications of Preoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement
T2 - Is There an Argument for Concomitant Arrhythmia Surgery?
AU - Ngaage, Dumbor L.
AU - Schaff, Hartzell V
AU - Barnes, Sunni A.
AU - Sundt, Thoralf M.
AU - Mullany, Charles J.
AU - Dearani, Joseph A.
AU - Daly, Richard C.
AU - Orszulak, Thomas A.
PY - 2006/10
Y1 - 2006/10
N2 - 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.
AB - 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.
UR - http://www.scopus.com/inward/record.url?scp=33748754282&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=33748754282&partnerID=8YFLogxK
U2 - 10.1016/j.athoracsur.2006.04.004
DO - 10.1016/j.athoracsur.2006.04.004
M3 - Article
VL - 82
SP - 1392
EP - 1399
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
SN - 0003-4975
IS - 4
ER -