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Systematic review and meta-analysis on the impact of preoperative atrial fibrillation on short- and long-term outcomes after aortic valve replacement.
- Source :
-
The Journal of cardiovascular surgery [J Cardiovasc Surg (Torino)] 2017 Dec; Vol. 58 (6), pp. 943-950. Date of Electronic Publication: 2017 Mar 20. - Publication Year :
- 2017
-
Abstract
- 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).<br />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.<br />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).<br />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.
- Subjects :
- Aged
Aged, 80 and over
Aortic Valve Insufficiency complications
Aortic Valve Insufficiency mortality
Aortic Valve Insufficiency physiopathology
Aortic Valve Stenosis complications
Aortic Valve Stenosis mortality
Aortic Valve Stenosis physiopathology
Atrial Fibrillation mortality
Atrial Fibrillation physiopathology
Chi-Square Distribution
Female
Hospital Mortality
Humans
Linear Models
Male
Middle Aged
Odds Ratio
Postoperative Complications etiology
Postoperative Complications mortality
Risk Assessment
Risk Factors
Time Factors
Treatment Outcome
Aortic Valve Insufficiency surgery
Aortic Valve Stenosis surgery
Atrial Fibrillation complications
Heart Valve Prosthesis Implantation adverse effects
Heart Valve Prosthesis Implantation instrumentation
Heart Valve Prosthesis Implantation mortality
Subjects
Details
- Language :
- English
- ISSN :
- 1827-191X
- Volume :
- 58
- Issue :
- 6
- Database :
- MEDLINE
- Journal :
- The Journal of cardiovascular surgery
- Publication Type :
- Academic Journal
- Accession number :
- 28322038
- Full Text :
- https://doi.org/10.23736/S0021-9509.17.09814-7