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REVIEW  CARDIAC SECTION 

The Journal of Cardiovascular Surgery 2017 December;58(6):943-50

DOI: 10.23736/S0021-9509.17.09814-7

Copyright © 2017 EDIZIONI MINERVA MEDICA

language: English

Systematic review and meta-analysis on the impact of preoperative atrial fibrillation on short- and long-term outcomes after aortic valve replacement

Akshat SAXENA 1, 2, Sohaib A. VIRK 2, Sebastian BOWMAN 3, Paul G. BANNON 1, 2, 4

1 Department of Cardiothoracic Surgery, Royal Prince Alfred Hospital, Sydney, Australia; 2 The Baird Institute, Sydney, Australia; 3 Melbourne Medical School, University of Melbourne, Melbourne, Australia; 4 Institute of Academic Surgery, The University of Sydney, Sydney, Australia


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INTRODUCTION: 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).
EVIDENCE ACQUISITION: 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.
EVIDENCE SYNTHESIS: 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.


KEY WORDS: Atrial fibrillation - Aortic valve - Survival - Mortality

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