E Anne Russell1, Warren F Walsh2, Lavinia Tran3, Robert Tam4, Christopher M Reid5, Alex Brown6, Jayme S Bennetts7, Robert A Baker8, Graeme P Maguire9. 1. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: anne.russell@monash.edu. 2. Prince of Wales Hospital, Randwick, NSW. Australia. Electronic address: warren.walsh@ehc.com.au. 3. School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia. Electronic address: lavinia.tran@monash.edu. 4. Department of Cardiothoracic Surgery, Townsville, Hospital, Queensland, Australia. Electronic address: robert.tam@health.qld.gov.au. 5. School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Public Health, Curtin University, Perth, WA, Australia. Electronic address: christopher.reid@curtin.edu.au. 6. Wardliparingga Aboriginal Research Unit, South Australia Health and Medical Research Institute, Adelaide, SA, Australia; School of Population Health, University of South Australia, Adelaide, SA, Australia. Electronic address: alex.brown@sahmri.com. 7. Department of Surgery, School of Medicine, Flinders University, Adelaide, SA, Australia; Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA, Australia. Electronic address: Jayme.Bennetts@health.sa.gov.au. 8. Department of Cardiac and Thoracic Surgery, Flinders Medical Centre, Adelaide, SA, Australia. Electronic address: Rob.Baker@health.sa.gov.au. 9. Baker IDI Heart and Diabetes Institute, Melbourne, Victoria, Australia; School of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; School of Medicine, James Cook University, Cairns, Queensland, Australia. Electronic address: graeme.maguire@bakeridi.edu.au.
Abstract
BACKGROUND: Atrial fibrillation (AF) is the most common preoperative arrhythmia in heart valve surgery patients and its prevalence is rising. This study aims to investigate the impact of AF on valve surgery early complications and survival and on valve disease of different aetiologies and populations with particular reference to Indigenous Australians with rheumatic heart disease (RHD). METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to determine the association between preoperative AF and valve surgery outcome. Its association with demographics, co-morbidities, preoperative status and short and long term outcome was assessed. RESULTS: Outcome of 1594 RHD and 19,029 non-RHD-related surgical procedures was analysed. Patients with preoperative AF were more likely to be older, female, Indigenous, to have RHD and to bear a greater burden of comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2-1.7) and long term (HR 1.5, 95% CI 1.3-1.7) survival was inferior for patients with non-RHD preoperative AF but was no different for Indigenous and non-Indigenous Australians with RHD. CONCLUSIONS: In this prospective Australian study, patients with valve disease and preoperative AF had inferior short and long term survival. This was particularly the case for patients with non-RHD valve disease. Earlier intervention or more aggressive AF management should be investigated as mechanisms for enhancing postoperative outcomes. This may influence treatment choice and the need for ongoing anticoagulation.
BACKGROUND:Atrial fibrillation (AF) is the most common preoperative arrhythmia in heart valve surgery patients and its prevalence is rising. This study aims to investigate the impact of AF on valve surgery early complications and survival and on valve disease of different aetiologies and populations with particular reference to Indigenous Australians with rheumatic heart disease (RHD). METHODS: The Australian and New Zealand Society of Cardiac and Thoracic Surgeons Cardiac Surgery Database was analysed to determine the association between preoperative AF and valve surgery outcome. Its association with demographics, co-morbidities, preoperative status and short and long term outcome was assessed. RESULTS: Outcome of 1594 RHD and 19,029 non-RHD-related surgical procedures was analysed. Patients with preoperative AF were more likely to be older, female, Indigenous, to have RHD and to bear a greater burden of comorbidities. Patients with RHD and preoperative AF had a longer hospital stay and were more likely to require reoperation. Adjusted short (OR 1.4, 95% CI 1.2-1.7) and long term (HR 1.5, 95% CI 1.3-1.7) survival was inferior for patients with non-RHD preoperative AF but was no different for Indigenous and non-Indigenous Australians with RHD. CONCLUSIONS: In this prospective Australian study, patients with valve disease and preoperative AF had inferior short and long term survival. This was particularly the case for patients with non-RHD valve disease. Earlier intervention or more aggressive AF management should be investigated as mechanisms for enhancing postoperative outcomes. This may influence treatment choice and the need for ongoing anticoagulation.
Authors: Jean Jacques Noubiap; Ulrich Flore Nyaga; Aude Laetitia Ndoadoumgue; Jan René Nkeck; Anderson Ngouo; Jean Joel Bigna Journal: Glob Heart Date: 2020-05-18