Conversion to sinus rhythm does not improve long-term survival after valve surgery: insights from a 20-year follow-up study.
OBJECTIVE
Atrial fibrillation (AF) is frequently associated with valvular heart disease and a common complication of valve surgery. Its contribution to long-term mortality and morbidity remains debated. Our objective was to determine the impact of AF on long-term mortality and embolic complications after valvular surgery and the benefit of conversion to sinus rhythm. This may provide insight to the clinical advantages of surgical anti-AF procedures.


METHODS
Data concerning rhythm status, mortality and embolic complications were prospectively collected for 5466 patients with valve surgery. Patients had surgery between 1979 and 2003. Follow-up was complete and all patients had a yearly EKG.


RESULTS
Patients with preoperative AF had poorer long-term survival than patients without preoperative AF (20-year survival 23.7 and 33.4%, respectively, P<0.0001). However, preoperative AF was not an independent risk factor of long-term mortality (HR=1.04, P=0.6). In patients with preoperative sinus rhythm, postoperative development of AF had an impact on long-term mortality (HR=1.46, P=0.0012). In patients with preoperative AF, postoperative rhythm did not influence mortality when adjusted for other variables (AF vs. sinus rhythm, HR=1.07, P=0.5709). Mitral valve surgery (HR=1.55, P=0.0270) but not preoperative or postoperative AF had a significant impact on the advent of embolic complications.


CONCLUSIONS
The conversion to sinus rhythm did not improve long-term survival or reduce the incidence of embolic complications after valve surgery. Patients with preoperative AF had poorer survival than patients without preoperative AF. AF may be a marker of advanced disease in these patients.
Chaput
Miguel
M
Department of Surgery, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Que., Canada H1T 1C8.
Bouchard
Denis
D
Demers
Philippe
P
Perrault
Louis P
LP
Cartier
Raymond
R
Carrier
Michel
M
Pagé
Pierre
P
Pellerin
Michel
M
D001021:Aortic Valve / Q000601:surgery; D001281:Atrial Fibrillation / Q000401:mortality*; D004617:Embolism / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006349:Heart Valve Diseases / Q000401:mortality* / Q000503:physiopathology / Q000601:surgery*; D019918:Heart Valve Prosthesis Implantation / Q000379:methods; D006351:Heart Valves / Q000601:surgery*; D006801:Humans; D008297:Male; D008943:Mitral Valve / Q000601:surgery; D011183:Postoperative Complications / Q000209:etiology; D011184:Postoperative Period; D011300:Preoperative Care; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors