Incidence and outcomes of post-operative atrial fibrillation after isolated surgical aortic valve replacement
Björn, Rikhard (2019-02-05)
Incidence and outcomes of post-operative atrial fibrillation after isolated surgical aortic valve replacement
(05.02.2019)
Julkaisu on tekijänoikeussäännösten alainen. Teosta voi lukea ja tulostaa henkilökohtaista käyttöä varten. Käyttö kaupallisiin tarkoituksiin on kielletty.
suljettu
Julkaisun pysyvä osoite on:
https://urn.fi/URN:NBN:fi-fe201902144902
https://urn.fi/URN:NBN:fi-fe201902144902
Tiivistelmä
Atrial fibrillation (AF) is a common complication after open heart surgery. However, little is known about the outcomes related to post-operative atrial fibrillation during index hospitalization. The aim of this study was to evaluate incidence and outcomes of post-operative atrial fibrillation in patients undergoing isolated surgical aortic valve replacement with a bioprosthesis or a mechanical prosthesis.
A total of 721 patients underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis at the four participating hospitals (Helsinki, Turku, Oulu, and Kuopio) and 298 patients underwent isolated SAVR with a mechanical prosthesis in Turku University Hospital during 2002–2014 (Helsinki 2006–2014). After the exclusion of patients with AF prior to the operation this resulted in a total of 529 patients in the bioprosthetic cohort and 253 patients in the mechanical cohort. Median follow-up time was 4.9 (interquartile range 3.1–7.0) years in the bioprosthetic cohort and 7.7 (interquartile range 4.4–11.0) years in the mechanical cohort.
Overall 265 (50.1%) patients developed in-hospital AF and 177 (33.5%) developed AF after hospital discharge in the bioprosthetic cohort. Similarly, of the patients in the mechanical cohort, a total of 64 (25.3%) developed in-hospital AF and 77 (30.4%) developed AF after discharge. Patients who developed AF during index hospitalization had a multifold risk of AF after hospital discharge in both bioprosthetic (HR 3.645, 95% CI 2.555–5.202, p<0.0001) and mechanical cohorts (HR 2.488, 95% CI 1.537–4.029, p<0.001). In the bioprosthetic cohort, AF during index hospitalization was associated with a higher risk of mortality after adjustment for EuroSCORE II (HR 1.541, 95% CI 1.116–2.127, p=0.009), but no significant effect was detected in the mechanical patient cohort (HR 1.642, 95% CI 0.875–3.083, p=0.123). No significant association between AF during index hospitalization and major strokes was detected (bioprosthetic cohort: HR 1.157, 95% CI 0.675–1.985, p=0.596; mechanical cohort: HR 2.108, 95% CI 0.731–6.079, p=0.168).
AF during index hospitalization leads to multifold risk of AF after hospital discharge in both bioprosthetic and mechanical isolated SAVR. AF during index hospitalization is associated with higher overall mortality in patients undergoing isolated SAVR with a bioprosthesis.
A total of 721 patients underwent isolated surgical aortic valve replacement (SAVR) with a bioprosthesis at the four participating hospitals (Helsinki, Turku, Oulu, and Kuopio) and 298 patients underwent isolated SAVR with a mechanical prosthesis in Turku University Hospital during 2002–2014 (Helsinki 2006–2014). After the exclusion of patients with AF prior to the operation this resulted in a total of 529 patients in the bioprosthetic cohort and 253 patients in the mechanical cohort. Median follow-up time was 4.9 (interquartile range 3.1–7.0) years in the bioprosthetic cohort and 7.7 (interquartile range 4.4–11.0) years in the mechanical cohort.
Overall 265 (50.1%) patients developed in-hospital AF and 177 (33.5%) developed AF after hospital discharge in the bioprosthetic cohort. Similarly, of the patients in the mechanical cohort, a total of 64 (25.3%) developed in-hospital AF and 77 (30.4%) developed AF after discharge. Patients who developed AF during index hospitalization had a multifold risk of AF after hospital discharge in both bioprosthetic (HR 3.645, 95% CI 2.555–5.202, p<0.0001) and mechanical cohorts (HR 2.488, 95% CI 1.537–4.029, p<0.001). In the bioprosthetic cohort, AF during index hospitalization was associated with a higher risk of mortality after adjustment for EuroSCORE II (HR 1.541, 95% CI 1.116–2.127, p=0.009), but no significant effect was detected in the mechanical patient cohort (HR 1.642, 95% CI 0.875–3.083, p=0.123). No significant association between AF during index hospitalization and major strokes was detected (bioprosthetic cohort: HR 1.157, 95% CI 0.675–1.985, p=0.596; mechanical cohort: HR 2.108, 95% CI 0.731–6.079, p=0.168).
AF during index hospitalization leads to multifold risk of AF after hospital discharge in both bioprosthetic and mechanical isolated SAVR. AF during index hospitalization is associated with higher overall mortality in patients undergoing isolated SAVR with a bioprosthesis.