Saxena A, Virk SA, Bowman S, Bannon PG

J Cardiovasc Surg (Torino) 2017 Mar;

PMID: 28322038

Abstract

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, peri-operative 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 peri-operative 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.