title: Impact of Preoperative Atrial Fibrillation on Postoperative Thromboembolic Events After Left Ventricular Assist Device Implantation.
abstract: BACKGROUND
  The incidence of atrial fibrillation (AF) among patients undergoing left ventricular assist device (LVAD) implantation is high. However, the impact of AF on clinical outcomes has not been clarified. We reviewed our 9-year experience of continuous flow (CF) LVADs to determine the impact of preoperative AF on stroke, device thrombosis, and survival.
  
  
  METHODS
  Between March 2006 and May 2015, 231 patients underwent implantation of 240 CF LVADs, 127 (52.9%) as bridge to transplantation and 113 (47.1%) as destination therapy. Effect of AF on postoperative outcomes was assessed by using Kaplan-Meier survival and Cox proportional hazard regression.
  
  
  RESULTS
  There were 78 patients (32.5%) with preoperative AF with a mean age of 55.7 ± 11.4 years. A similar incidence of stroke was found in patients with and without AF, 12.8% versus 16.0%, respectively (p = 0.803). Survival was similar, with 1-, 6-, 12-, and 24-month survivals of 96.2%, 91.7%, 84.5%, and 69.2%, respectively, for AF patients, versus 93.1%, 85.0%, 79.4%, and 74.1%, respectively, for non-AF patients (p = 0.424). Preoperative AF was not a significant independent predictor of survival with the use of Cox proportional hazard regression (hazard ratio 1.08, 95% confidence interval: 0.66 to 1.76).
  
  
  CONCLUSIONS
  Preoperative AF was associated with a similar incidence of postoperative stroke, device thrombosis, and survival. On the basis of these data, it seems unnecessary to perform a left atrial appendage ligation or to alter postoperative anticoagulation in patients with AF undergoing LVAD implantation.
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Linnea
authors.initials: L
authors.lastname: Xuereb
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Pauline H
authors.initials: PH
authors.lastname: Go
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Babbaljeet
authors.initials: B
authors.lastname: Kaur
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Silvy
authors.initials: S
authors.lastname: Akrawe
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Hassan W
authors.initials: HW
authors.lastname: Nemeh
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Jamil
authors.initials: J
authors.lastname: Borgi
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Celeste T
authors.initials: CT
authors.lastname: Williams
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan.
authors.forename: Gaetano
authors.initials: G
authors.lastname: Paone
authors.affiliation: Division of Cardiothoracic Surgery, Henry Ford Hospital, Heart and Vascular Institute, Detroit, Michigan. Electronic address: jamorganmd@hotmail.com.
authors.forename: Jeffrey A
authors.initials: JA
authors.lastname: Morgan
mesh_terms: D000328:Adult; D000368:Aged; D000925:Anticoagulants / Q000008:administration & dosage / Q000627:therapeutic use; D020517:Atrial Appendage / Q000601:surgery; D001281:Atrial Fibrillation / Q000150:complications*; D004198:Disease Susceptibility; D004868:Equipment Failure; D005260:Female; D006333:Heart Failure / Q000150:complications / Q000601:surgery; D006353:Heart-Assist Devices / Q000009:adverse effects; D006801:Humans; D015994:Incidence; D007362:Intensive Care Units / Q000706:statistics & numerical data; D053208:Kaplan-Meier Estimate; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D016016:Proportional Hazards Models; D020521:Stroke / Q000453:epidemiology / Q000209:etiology; D013923:Thromboembolism / Q000453:epidemiology / Q000209:etiology*; D019851:Thrombophilia / Q000188:drug therapy / Q000209:etiology; D016896:Treatment Outcome; D019564:Unnecessary Procedures
chemical_list: D000925:Anticoagulants