Systematic review and meta-analysis on the impact of preoperative atrial fibrillation on short- and long-term outcomes after aortic valve replacement.
BACKGROUND
This systematic review and meta-analysis was performed to evaluate the impact of preoperative atrial fibrillation (preAF) on early and late outcomes after aortic valve replacement (AVR).


METHODS
Medline, EMBASE, and CENTRAL were systematically searched for studies that reported AVR outcomes according to the presence or absence of preAF. Data were independently extracted by two investigators; a meta-analysis was conducted according to predefined clinical endpoints. Studies including patients undergoing concomitant atrial fibrillation surgery were excluded.


RESULTS
Six observational studies with 8 distinct AVR cohorts (AVR± concomitant surgery) met criteria for inclusion, including a total of 6693 patients. Of these, 1014 (15%) presented with preAF. Overall, perioperative mortality was increased in patients with preAF (odds ratio [OR] 2.33; 95% CI: 1.48-3.67; P<0.001). Subgroup analysis of patients undergoing isolated AVR also demonstrated preAF as a risk factor for perioperative mortality (OR 2.49; 95% CI: 1.57-3.95; P<0.001). PreAF was also associated with acute renal failure (OR 1.42; 95% CI: 1.07-1.89; P=0.02) but not stroke (OR 1.11; 95% CI: 0.59-2.12; P=0.74). Late mortality was significantly higher in patients with preAF (hazard ratio [HR] 1.75; 95% CI: 1.33-2.30; P<0.001). This relationship remained true when only patients who underwent isolated AVR were analyzed (HR 1.97; 95% CI: 1.11-3.51; P=0.02).


CONCLUSIONS
PreAF is associated with an increased risk of early- and late-mortality after AVR. These data support the more widespread utilization of concomitant AF ablation.
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia.|The Baird Institute, Sydney, Australia.
Akshat
A
Saxena
The Baird Institute, Sydney, Australia.
Sohaib A
SA
Virk
Melbourne Medical School, University of Melbourne, Melbourne, Australia.
Sebastian
S
Bowman
Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia - pgbannon@gmail.com.|The Baird Institute, Sydney, Australia.|Institute of Academic Surgery, The University of Sydney, Sydney, Australia.
Paul G
PG
Bannon
D000368:Aged; D000369:Aged, 80 and over; D001022:Aortic Valve Insufficiency / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001024:Aortic Valve Stenosis / Q000150:complications / Q000401:mortality / Q000503:physiopathology / Q000601:surgery*; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D016009:Chi-Square Distribution; D005260:Female; D019918:Heart Valve Prosthesis Implantation / Q000009:adverse effects / Q000295:instrumentation / Q000401:mortality; D017052:Hospital Mortality; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011183:Postoperative Complications / Q000209:etiology / Q000401:mortality; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome