Worse Survival In Af Patients Undergoing Midcab Surgery.analysis From The Polish National Registry Of Cardiac Surgery Procedures (krok)
Mariusz Kowalewski1, Michał Pasierski1, Jakub Staromłyński1, Marian Zembala2, Marek Deja3, Mariusz Kuśmierczyk4, Paweł Kwinecki5, Ryszard Stanisławski6, Marek Cisowski7, Bogusław Kapelak8, Zdzisław Tobota9, Bohdan Maruszewski9, Piotr Suwalski1.
1CSK MSWiA, Warsaw, Poland, 2SCCS, Zabrze, Poland, 3Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland, 4Department of Cardiac Surgery and Transplantology, The Institute of Cardiology, Warsaw, Poland, 5Medinet Sp. z o.o. Szpital Kardiochirurgiczny Wrocław, Wrocław, Poland, 6Medinet Sp. z o.o. Szpital Kardiochirurgiczny Filia w Nowej Soli, Nowa Sól, Poland, 7Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland, 87. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, Medical College, John Paul II Hospital, Kraków, Poland, 9CZD, Warsaw, Poland.
OBJECTIVE:The presence of preoperative atrial fibrillationin patients undergoing coronary surgery, albeit much less than in patients admitted for isolated mitral valve surgery, reaches up to 6% and accounts for substantial morbidity shortly after procedure and in long-term. In the current analysis we report long-term survival results after minimally invasive direct coronary bypass (MIDCAB) surgery for patients with preoperative AF. METHODS:Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. 3,901 patients underwent MIDCAB procedure surgery between 2006-2019 across Poland and were included in the registry. RESULTS: Of included patients, 214 (5.5%) had preoperative AF. 72.4% of included subjects were men, mean age 65.0±9.9, mean EuroSCORE II 1.74±2.68. All patients underwent MIDCAB and had LIMA-LAD anastomosis performed. Mean length of hospital stay was 5.98 days. AF patients were older 70.1 vs 64.7 y.o (P<0.001) and of higher baseline EuroSCORE 3.49 vs 1.68 (P<0.001). Median duration of follow-up was 4 years (3.8, IQR [1.7-6.1]). During 12-year study period, there was over 2.5-fold increase in mortality risk in patients with AF as compared to those without AF: Hazard Ratio: 2.66, 95% Confidence Intervals (2.01-3.54); P<0.001. Age, EuroSCORE and presence of AF were all independently associated with worse survival. Additionally, presence of AF predicted mortality also in otherwise low risk patients (EuroSCORE <1: [P=0.006], age <50: [P<0.001]). CONCLUSIONS:Presence of atrial fibrillation is associated with over 2.5-fold increased mortality risk in patients undergoing minimally invasive direct coronary bypass surgery.
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