Prognostic Implications of Preoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement

Is There an Argument for Concomitant Arrhythmia Surgery?

Dumbor L. Ngaage, Hartzell V Schaff, Sunni A. Barnes, Thoralf M. Sundt, Charles J. Mullany, Joseph A. Dearani, Richard C. Daly, Thomas A. Orszulak

Research output: Contribution to journalArticle

75 Citations (Scopus)

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 languageEnglish (US)
Pages (from-to)1392-1399
Number of pages8
JournalAnnals of Thoracic Surgery
Volume82
Issue number4
DOIs
StatePublished - Oct 2006

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Aortic Valve
Atrial Fibrillation
Cardiac Arrhythmias
Heart Failure
Odds Ratio
Tricuspid Valve Insufficiency
Mortality
Stroke Volume
Survival Rate
Stroke
Morbidity
Survival

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 journalArticle

Ngaage, Dumbor L. ; Schaff, Hartzell V ; Barnes, Sunni A. ; Sundt, Thoralf M. ; Mullany, Charles J. ; Dearani, Joseph A. ; Daly, Richard C. ; Orszulak, Thomas A. / Prognostic Implications of Preoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement : Is There an Argument for Concomitant Arrhythmia Surgery?. In: Annals of Thoracic Surgery. 2006 ; Vol. 82, No. 4. pp. 1392-1399.
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title = "Prognostic Implications of Preoperative Atrial Fibrillation in Patients Undergoing Aortic Valve Replacement: Is There an Argument for Concomitant Arrhythmia Surgery?",
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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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.

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