In patients undergoing aortic valve surgery, new-onset atrial fibrillation was associated with a significantly higher risk of all-cause mortality (HR 1.16) compared to patients without atrial fibrillation.
Cohort (n=28,492)
Yes
Does atrial fibrillation status (new or prior) increase the risk of all-cause mortality and non-fatal outcomes in patients undergoing open-heart cardiac valve surgery?
Prior and new-onset atrial fibrillation are associated with increased all-cause mortality in patients undergoing aortic valve surgery, whereas only prior AF is associated with increased mortality in mitral valve surgery.
Effect estimate: HR 1.16 (95% CI 1.10-1.22)
Absolute Event Rate: 41.5% vs 32.8%
p-value: p=<0.001
Abstract Background Atrial fibrillation (AF) is common after cardiac surgery. Few studies compared clinical outcomes associated with AF between patients undergoing aortic valve surgery (AVSx) versus mitral valve surgery (MVSx). Methods Patients who had open-heart cardiac valve surgery (1- July-2003 to 31-March-2021) identified from the Admitted-Patient-Data-Collection database in Australia were stratified by AF status (No-AF vs. New-AF vs. Prior-AF during index valve surgery) and followed up to 31-March-2022. Multivariable Cox regression and Fine-Gray competing risk analyses were performed to assess the association of AF status on all-cause mortality and non-fatal outcomes respectively. Results The cohort comprised 28,492 patients (whole cohort median age 71.6yrs interquartile range 62.7–78.3yrs; 65.6% males): AVSx, n = 18,949, median age 73.3 IR 65.4–79.4yrs, 67.8% males; MVSx, n = 9543, MVSx: median age 67.6 IR 58.2–75.5yrs, 61.2% males. During a median 6.58yrs (3.4–10.5yrs) follow-up, Prior-AF and New-AF patients had significantly higher all-cause mortality (AVSx-Prior-AF: 57.9% vs. AVSx-New-AF: 41.5% vs. AVSx-No-AF: 32.8%; MVSx-Prior-AF: 41.0% vs. MVSx-New-AF: 29.8% vs. MVSx-No-AF: 22.4%) (both logrank P < 0.001). In the AVSx subgroup, both New-AF and Prior-AF were independently associated with all-cause mortality (aHR = 1.16, 95%CI = 1.10–1.22; aHR = 1.69, 95%CI = 1.59–1.79 respectively) compared to No-AF patients. In the MVSx subgroup, only Prior-AF was associated with increased all-cause mortality (aHR = 1.47, 95% CI = 1.33–1.61), all P < 0.001. Ischaemic stroke was significantly higher in the AVSx New-AF and AVSx-Prior-AF subgroups. Conclusions Patients undergoing valve surgery have different risks of adverse clinical outcomes, with target valve and baseline AF status being associated with these outcomes.
Ne et al. (Wed,) conducted a cohort in Open-heart cardiac valve surgery (n=28,492). New-onset atrial fibrillation (New-AF) vs. No atrial fibrillation (No-AF) was evaluated on All-cause mortality (Aortic valve surgery subgroup) (HR 1.16, 95% CI 1.10-1.22, p=<0.001). In patients undergoing aortic valve surgery, new-onset atrial fibrillation was associated with a significantly higher risk of all-cause mortality (HR 1.16) compared to patients without atrial fibrillation.