Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement

Mary Rezk; Amar Taha; Susanne J Nielsen; Andreas Martinsson; Lennart Bergfeldt; Tomas Gudbjartsson; Stefan Franzén; Anders Jeppsson

doi:10.1093/ejcts/ezad103

Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement

Eur J Cardiothorac Surg. 2023 May 2;63(5):ezad103. doi: 10.1093/ejcts/ezad103.

Authors

Mary Rezk^{1

2}, Amar Taha^{1

3}, Susanne J Nielsen^{1

2}, Andreas Martinsson^{1

3}, Lennart Bergfeldt^{1

3}, Tomas Gudbjartsson^{4

5}, Stefan Franzén⁶, Anders Jeppsson^{1

2}

Affiliations

¹ Department of Molecular and Clinical Medicine, Institute of Medicine, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
² Department of Cardiothoracic Surgery, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
³ Department of Cardiology, Region Västra Götaland, Sahlgrenska University Hospital, Gothenburg, Sweden.
⁴ Department of Cardiothoracic Surgery, Landspitali University Hospital, Reykjavik, Iceland.
⁵ Faculty of Medicine, University of Iceland, Reykjavik, Iceland.
⁶ Centre for Registries, Region Västra Götaland, Gothenburg, Sweden.

Abstract

Objectives: Data on prognostic implications of new-onset postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) is limited. We sought to explore associations between POAF, early initiated oral anticoagulation (OAC) and long-term outcome after SAVR and combined SAVR + coronary artery bypass grafting (CABG).

Methods: This is a retrospective, population-based study including all isolated SAVR (n = 7038) and combined SAVR and CABG patients (n = 3854) without a history of preoperative atrial fibrillation (AF) in Sweden 2007-2017. Individual patient data were merged from 4 nationwide registries. Inverse probability of treatment weighting-adjusted Cox regression models were employed separately in SAVR and SAVR + CABG patients. The median follow-up time was 4.7 years (range 0-10 years).

Results: POAF occurred in 44.5% and 50.7% of SAVR and SAVR + CABG patients, respectively. In SAVR patients, POAF was associated with increased long-term risk of death [adjusted hazard ratio (aHR) 1.21 (95% confidence interval 1.06-1.37)], ischaemic stroke [aHR 1.32 (1.08-1.59)], any thromboembolism, heart failure hospitalization and recurrent AF. In SAVR + CABG, POAF was associated with death [aHR 1.31 (1.14-1.51)], recurrent AF and heart failure, but not with ischaemic stroke [aHR 1.04 (0.84-1.29)] or thromboembolism. OAC was dispensed within 30 days after discharge to 67.0% and 65.9%, respectively, of SAVR and SAVR + CABG patients with POAF. Early initiated OAC was not associated with reduced risk of death, ischaemic stroke or thromboembolism in any group of patients.

Conclusions: POAF after SAVR is associated with an increased risk of long-term mortality and morbidity. Further studies are warranted to clarify the role of OAC in SAVR patients with POAF.

Keywords: Coronary artery bypass grafting; Postoperative atrial fibrillation; Surgical aortic valve replacement.

MeSH terms

Aortic Valve / surgery
Atrial Fibrillation* / complications
Atrial Fibrillation* / etiology
Brain Ischemia*
Heart Failure* / complications
Humans
Postoperative Complications / epidemiology
Retrospective Studies
Risk Factors
Stroke* / epidemiology
Stroke* / etiology
Thromboembolism* / complications
Thromboembolism* / etiology

Grants and funding

20210433/Swedish Heart-Lung Foundation