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Current Research: Cardiology

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Impact of atrial fibrillation on long-term survival after cardiac valve surgery with or without coronary artery bypass

Author(s): Nasir Shariff*, Vadim Levin, Abdul Bari Akbar, Ravi V Desai, Sherrine Eid, Michael J Weiss, Matthew W Martinez, Alaa Shalaby and Ronald Freudenberger

Background: Atrial fibrillation (AF) is the most common arrhythmia in patients undergoing cardiac valve surgery. AF in patients undergoing surgery can be categorized as preoperative AF (PPAF) or postsurgical AF (PSAF).

Objective: To determine whether PSAF in patients undergoing valve surgery had an impact on mortality compared with patients in sinus rhythm or PPAF.

Methods: A total of 556 consecutive patients who underwent valve surgery were reviewed. Patients were divided into three cohorts: sinus rhythm before and after surgery (n=293); PPAF (n=139); and sinus rhythm before and AF after the surgery (PSAF) (n=124). Baseline characteristics, surgical details and outcomes were recorded.

Results: Compared with patients in sinus rhythm (mean [± SD] age 67.8±12.5 years), patients in the PPAF and PSAF groups were significantly older (73.1±9.9 years and 72.4±9.9 years, respectively). Hospital stay was significantly longer in the PPAF and PSAF groups (10.5±6.1 days and 11.3±8.3 days, respectively) compared with patients with sinus rhythm (7.12±4.9 days). During a follow-up of 51 months, all-cause mortality was significantly higher in both the PPAF and PSAF groups. This was irrespective of concomitant coronary bypass surgery. On multivariate Cox regression analysis, the adjusted risk for all-cause mortality for PPAF and PSAF was 1.93 (95% CI 1.18 to 3.17; P=0.01) and 1.64 (95% CI 1.07 to 2.53; P=0.02), respectively.

Conclusion: Patients with PSAF and PPAF have longer hospital stays and higher long-term mortality rates than patients in sinus rhythm. Long-term mortality was similar between PPAF and PSAF.

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Current Research: Cardiology