What is the clinical evidence from this study?

Study design: Cohort. Population: Postoperative atrial fibrillation (n=219). Intervention: Bioprosthetic aortic valve replacement. Primary outcome: Mid-term postoperative atrial fibrillation (MT-POAF) (OR 5.93, 95% CI 2.96-11.8).

January 1, 2014Circulation Journal11 citationsOpen Access

Atrial Fibrillation at Mid-Term After Bioprosthetic Aortic Valve Replacement

Q: What does this research mean for the field?

Early postoperative atrial fibrillation, previous atrial fibrillation, and higher body mass index are independent predictors of mid-term atrial fibrillation after bioprosthetic aortic valve replacement, which occurs at a higher than expected rate. Novelty: ClaimNovelty.NOVEL_FINDING. Consensus alignment: ConsensusAlignment.NEUTRAL.

FTFrancesco ToselloAzienda Sanitaria Ospedaliera S.Croce e Carle Cuneo EFEmmanuelle FlorensHôpital Européen TCThibaut CarubaHôpital Européen

Key Result

Early postoperative AF (OR 5.93; 95% CI 2.96-11.8), previous AF, and higher BMI independently predicted mid-term atrial fibrillation after bioprosthetic aortic valve replacement.

Study Design

Type

Cohort (n=219)

Structured PICO

Population

176 adults without a preoperative history of atrial fibrillation who underwent bioprosthetic aortic valve replacement (BAVR), mean age 70.5, 67% male, single-center (France). Key exclusions: preoperative AF, mitral valve surgery, age <18 years, and early death in ICU.

Intervention

Bioprosthetic aortic valve replacement (BAVR) with 3-month postoperative monitoring

Outcome

Mid-term postoperative atrial fibrillation (MT-POAF) at 30 and 90 dayshard clinical

Mid-term postoperative atrial fibrillation is common (20.4%) after bioprosthetic aortic valve replacement, particularly in overweight patients with early POAF, suggesting a potential need for anticoagulation rather than antiplatelet therapy alone.

Main Result

Effect estimate: OR 5.93 (95% CI 2.96-11.8)

Abstract

BACKGROUND: Little is known about mid-term (3-month) postoperative atrial fibrillation (MT-POAF) in patients treated with bioprosthetic aortic valve replacement (BAVR). The aim of this study was to describe the natural history, identify the predictors and investigate the potential consequences in terms of anti-thrombotic therapy. METHODS AND RESULTS: During a longitudinal, prospective study, 219 patients were treated with BAVR early (7 days) and at mid-term postoperatively (30 and 90 days). POAF was monitored and risk factors were identified on logistic regression analysis. History of previous AF (OR, 3.08; 95% CI: 1.35-6.98), early POAF (OR, 5.93; 95% CI: 2.96-11.8), and BMI (per 5 kg/m(2): OR, 1.46; 95% CI: 1.03-2.09), were independent predictors for MT-POAF whereas sex, age and Euroscore were not. Results were identical when restricted to the 176 patients free from preoperative AF. In this subgroup, 36 patients (20.4%) had MT-POAF; 33 out of 174 (18.7%) would have required anticoagulation (CHA2DS2VASc score ≥ 1). Conversely, patients with BMI <27.7 and sinus rhythm at early follow-up had a very low risk of MT-POAF (OR, 0.16; 95% CI: 0.06-0.42). CONCLUSIONS: There was a higher than expected occurrence of MT-POAF in patients treated with BAVR, particularly in overweight patients with early POAF. This raises the question of implementing an anti-thrombotic therapy in these patients at higher risk of delayed atrial arrhythmia.

KI fragen

Bookmark

View Full Paper