Preoperative predictors of new-onset prolonged atrial fibrillation after surgical aortic valve replacement.

Patients undergoing surgical aortic valve replacement (SAVR) are at risk of developing prolonged atrial fibrillation (AF) after surgery. Prophylactic interventions such as left atrial appendage amputation (LAAA) and pulmonary vein isolation (PVI) impose cost and operative risk, discouraging routine use. To guide such interventions, we investigated preoperative predictors of AF. A retrospective analysis was performed on patients undergoing SAVR between 2011 and 2017. Patients were excluded if they had a preoperative history of AF or underwent a LAAA or PVI. Baseline characteristics were compared between those who did and did not develop prolonged postoperative AF. Predictors of prolonged AF were identified using multivariable logistic regression. Of 720 patients identified, 170 (25%) developed prolonged (beyond 30 days) AF. Compared with patients who did not develop AF, those who developed prolonged AF were older (70.1 vs 62.4 years, P <.001), had a greater incidence of hypertension (78% vs 61%, P <.001), and were less likely to smoke (16% vs 31%, P <.01). On multivariable regression, older age (odds ratio, 1.05; P <.01) and left atrial enlargement (odds ratio, 1.66; P =.04) were predictors of prolonged AF. In this high-risk cohort, the incidence of prolonged postoperative AF was 40%. Older age and left atrial enlargement identify a stratum of patients at high risk of developing prolonged postoperative AF after SAVR. Multicenter, prospective studies should investigate the value of prophylactic interventions such as LAAA, Cox maze, or PVI in these individuals to obviate the consideration of late anticoagulation. Advanced age and left atrial enlargement are risk factors for prolonged AF after SAVR. [ABSTRACT FROM AUTHOR]

Copyright of Journal of Thoracic & Cardiovascular Surgery is the property of Elsevier B.V. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)