title: Postoperative atrial fibrillation predicts long-term survival after aortic-valve surgery but not after mitral-valve surgery: a retrospective study.
abstract: Background Postoperative atrial fibrillation (POAF) has been reported to be associated with reduced long-term survival after isolated coronary artery bypass grafting surgery. The objective of this study was to determine the impact of POAF on long-term survival after valvular surgery.  Methods The authors retrospectively analysed the preoperative and operative data of 2986 consecutive patients with no preoperative history of atrial fibrillation undergoing first valvular surgery (aortic-valve replacement (AVR), mitral valve replacement or mitral valve repair (MVR/MVRp) with or without coronary artery bypass grafting surgery) in their institution between 1995 and 2008 (median follow-up 5.31 years, range 0.1-15.0). The authors investigated the impact of POAF on survival using multivariable Cox regression.  Results Patients with POAF were older, and were more likely to have hypertension or renal failure when compared with patients without POAF. The 12-year survival in patients with POAF was 45.7±2.8% versus 61.4±2.1% in patients without POAF (p<0.001). On a multivariable analysis, when adjusting for age and other potential confounding factors, POAF tended to be associated with lower long-term survival (HR for all-cause death (HR)=1.17, 95% CI 1.00 to 1.38, p=0.051). The authors also analysed this association separately in patients with AVR and those with MVR/MVRp. In the multivariable analysis, POAF was a significant predictor of higher long-term mortality in patients with AVR (HR=1.22, CI 1.02 to 1.45, p=0.03) but not in patients with MVR/MVRp (HR=0.87, CI 0.58 to 1.29, p=0.48).  Conclusions POAF is significantly associated with long-term mortality following AVR but not after MVR/MVRp. The underlying factors involved in the pathogenesis of POAF after MVR/MVRp may partially account for the lack of association between POAF and survival in these patients.
authors.affiliation: Department of Medicine, Laval University, Quebec, Canada.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Girerd
authors.forename: Julien
authors.initials: J
authors.lastname: Magne
authors.forename: Philippe
authors.initials: P
authors.lastname: Pibarot
authors.forename: Pierre
authors.initials: P
authors.lastname: Voisine
authors.forename: François
authors.initials: F
authors.lastname: Dagenais
authors.forename: Patrick
authors.initials: P
authors.lastname: Mathieu
references.citation: Eur Heart J. 2009 May;30(10):1270-8
references.pmid: 19329496
references.citation: Circulation. 1997 Nov 18;96(10):3542-8
references.pmid: 9396453
references.citation: Am J Cardiol. 2004 May 1;93(9):1176-8
references.pmid: 15110218
references.citation: Prog Cardiovasc Dis. 1989 Mar-Apr;31(5):367-78
references.pmid: 2646657
references.citation: Heart Surg Forum. 2007;10(2):E131-5
references.pmid: 17597037
references.citation: J Am Coll Cardiol. 2004 Mar 3;43(5):742-8
references.pmid: 14998610
references.citation: J Am Coll Cardiol. 2008 Feb 26;51(8):793-801
references.pmid: 18294562
references.citation: Circulation. 2007 Sep 11;116(11 Suppl):I213-9
references.pmid: 17846306
references.citation: Ann Surg. 1997 Oct;226(4):501-11; discussion 511-3
references.pmid: 9351718
references.citation: Ann Thorac Surg. 2009 Dec;88(6):1871-6
references.pmid: 19932252
references.citation: Ann Thorac Surg. 2010 Aug;90(2):474-9
references.pmid: 20667332
references.citation: J Am Coll Cardiol. 2010 Mar 30;55(13):1370-6
references.pmid: 20338499
references.citation: Circulation. 2008 Oct 14;118(16):1612-8
references.pmid: 18824644
references.citation: Circ Cardiovasc Qual Outcomes. 2009 May;2(3):164-9
references.pmid: 20031833
references.citation: JAMA. 2007 Apr 11;297(14):1562-7
references.pmid: 17426275