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Atrial Fibrillation In Aortic Valve Surgery
Johannes Petersen1, Lukas Narjes
1, Ilia Bazhanov
1, Justus Taube
1, Yalin Yildirim
1, Yousuf Al Assar
2, Hermann Reichenspurner
1, Simon Pecha
1;
1University Heart & Vascular Center Hamburg, Hamburg, Germany,
2University Heart & Vascular Center Hamburg,
20251 Hamburg, Germany
Objective This study aimed to thoroughly analyze the incidence and risk factors of postoperative atrial fibrillation (POAF) following aortic valve surgery (AVS), recognizing its role in increasing patient morbidity and hospital stay lengths.
Methods The study encompassed 264 patients undergoing AVS at our center from January 2016 to November 2018, all without prior atrial fibrillation. The primary goal was to ascertain the incidence of POAF and identify predictive factors through logistic regression analysis.
Results POAF occurred in 23.1% of patients (61 out of 264). At discharge, 5.7% of patients (15 out of 264) were still experiencing atrial fibrillation. Conversion in sinus rhythm (SR) was possible in 46/61 patients (75.4 %) of the patients with POAF due to substitution of electrolytes (11.4 %), betablocker (9.8 %) or amiodarone (6.5 %) and electric cardioversion (4.9 %). Combination of electrolytes and betablocker (6.5 %) or electrolytes and amiodarone (9.8 %) was also necessary. All three supplements were necessary in 22/61 cases (36 %). Cardiopulmonary bypass time (no POAF: 135.4±46.9 minutes vs. POAF: 142.3±59.7 minutes; p = 0.357) and aortic cross clamp time (no POAF: 86.3±33.6 minutes vs. POAF: 94.6±38.4 minutes; p = 0.109) did not differ significantly between both groups. Rate of POAF was significantly higher in patients with arterial hypertension (73.3 % vs. 54.3. %; p = 0.009) and dyslipidemia (48.3 % vs. 29.4 %; p = 0.007) compared to patients without postoperative AF (54.3 %); p = 0.009. Furthermore, aortic valve stenosis was more common in patients with POAF (75.0 %) compared to no postoperative AF (50.8 %); p = 0.001. Minimally invasive access was not associated with an increased risk of POAF (p=0.545). Concomitant procedures (eg. mitral/tricuspid valve surgery, coronary artery bypass grafts) did not increase the risk of POAF (p = 0.551). Arterial hypertension (OR 2.61;CI(95%):1.27;5.4;p=0.009), dyslipidemia (OR 1.95; CI(95%):1.01; 3.75;p=0.046) and aortic stenosis (OR 3.59;CI(95%):1.74;7.42;p=0.001) were identified as predictors for POAF in AVS.
Conclusion Postoperative atrial fibrillation in aortic valve disease patients represents a significant clinical issue, with arterial hypertension, dyslipidemia, and aortic stenosis identified as independent risk factors. Addressing these risks could be key in future research to reduce POAF prevalence in this patient group.
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