title: Incidence of postoperative atrial fibrillation in patients undergoing minimally invasive versus median sternotomy valve surgery.
abstract: BACKGROUND
  Atrial fibrillation (AF) after cardiac surgery is associated with increased morbidity and hospital length of stay. Our objective was to determine whether a minimally invasive approach to isolated valve surgery reduced the incidence of postoperative AF.
  
  
  METHODS
  Patients without a history of arrhythmia, who underwent isolated aortic or mitral valve surgery between January 2005 and August 2011, were included. The incidence of postoperative AF in those who underwent a minimally invasive approach was compared with that of patients undergoing median sternotomy surgery. Resource utilization was approximated on the basis of intensive care unit and total hospital lengths of stay.
  
  
  RESULTS
  A total of 571 patients were identified (413 minimally invasive and 158 median sternotomy). No significant differences in baseline characteristics existed between groups. The incidence of postoperative AF (25% vs 37%; P = .002), use of intraoperative blood products (52% vs 83%; P < .001), and prolonged intubation (≥24 hours) (12% vs 20%; P = .008) were significantly less in the minimally invasive group. The intensive care unit and hospital lengths of stay were 45 hours (interquartile range [IQR], 28-66 hours) versus 53 hours (IQR, 45-91 hours) (P < .001), and 5 days (IQR, 4-7 days) versus 8 days (IQR, 6-11 days) (P < .001) for the minimally invasive and median sternotomy groups, respectively. Multivariable analysis revealed a decreased risk of postoperative AF in patients undergoing minimally invasive surgery (odds ratio, 0.4; 95% confidence intervals, 0.24-0.66; P < .001).
  
  
  CONCLUSIONS
  A minimally invasive approach for isolated valve surgery reduces postoperative AF and resource use when compared with median sternotomy.
authors.affiliation: Columbia University Division of Cardiology, Mount Sinai Heart Institute, Miami Beach, Fla.
authors.forename: Christos G
authors.initials: CG
authors.lastname: Mihos
authors.forename: Orlando
authors.initials: O
authors.lastname: Santana
authors.forename: Gervasio A
authors.initials: GA
authors.lastname: Lamas
authors.forename: Joseph
authors.initials: J
authors.lastname: Lamelas
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001021:Aortic Valve / Q000601:surgery*; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000453:epidemiology* / Q000517:prevention & control; D006348:Cardiac Surgical Procedures / Q000009:adverse effects*; D016009:Chi-Square Distribution; D005260:Female; D005431:Florida / Q000453:epidemiology; D006295:Health Resources / Q000706:statistics & numerical data; D006349:Heart Valve Diseases / Q000175:diagnosis / Q000453:epidemiology / Q000601:surgery*; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units; D007902:Length of Stay; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D019060:Minimally Invasive Surgical Procedures; D008943:Mitral Valve / Q000601:surgery*; D015999:Multivariate Analysis; D016017:Odds Ratio; D012189:Retrospective Studies; D012307:Risk Factors; D056346:Sternotomy / Q000009:adverse effects*; D013997:Time Factors; D016896:Treatment Outcome