Postoperative Atrial Fibrillation In Mitral Surgery Is Not Benign

MP045 

Abstract Submission 

Whitney Fu (1), China Green (1), Gurnoordeep Pawar (1), Nicolas Ceniza (1), Rhea Gupta (1), Corina Ghita (1), Marco Bologna (1), Dani Ahmetovic (1), Tanvi Ravi (1), Jack Proebstle (1), Vivica Addrow (1), Catherine Wagner (1), Matthew Romano (1), Gorav Ailawadi (1), Steven Bolling (1)

(1) University of Michigan Cardiac Surgery, Ann Arbor, MI

Whitney Fu    -  Contact Me
University of Michigan Cardiac Surgery

China Green    -  Contact Me
University of Michigan Cardiac Surgery

Gurnoordeep Pawar    -  Contact Me
University of Michigan Cardiac Surgery

Nicolas Ceniza    -  Contact Me
University of Michigan Cardiac Surgery

Rhea Gupta    -  Contact Me
University of Michigan Cardiac Surgery

Corina Ghita    -  Contact Me
University of Michigan Cardiac Surgery

Marco Bologna    -  Contact Me
University of Michigan Cardiac Surgery

Dani Ahmetovic    -  Contact Me
University of Michigan Cardiac Surgery

Tanvi Ravi    -  Contact Me
University of Michigan Cardiac Surgery

Jack Proebstle    -  Contact Me
University of Michigan Cardiac Surgery

Vivica Addrow    -  Contact Me
University of Michigan Cardiac Surgery

Catherine Wagner    -  Contact Me
University of Michigan Cardiac Surgery

*Matthew Romano    -  Contact Me
University of Michigan Cardiac Surgery

*Gorav Ailawadi    -  Contact Me
University of Michigan Cardiac Surgery

*Steven Bolling    -  Contact Me
University of Michigan Cardiac Surgery

Whitney Fu    -  Contact Me
N/A

Objective: Postoperative atrial fibrillation (POAF) is common after cardiac surgery with an incidence of 20-40%. POAF is often regarded to be "benign," however recent data suggest worse long-term outcomes with POAF. Furthermore, there are no guidelines for the amount of POAF that triggers anticoagulation. Therefore, we examined the rate of POAF, incidence of subsequent neurologic events, and mortality in patients undergoing isolated mitral valve surgery at a Mitral Foundation reference center.
Methods: Adult patients from 2011-2022 with no history of AF, SVT, or heart block undergoing isolated mitral valve surgery (88% were repaired) at a Mitral Foundation reference center were included. Primary outcomes were incidence of POAF (STS definition within 30 days), neurologic event rate, development of new/recurrent AF after the postoperative period, and long-term survival. Perioperative strokes (<72 hrs) were censored. The majority of patients were discharged on aspirin and anticoagulation. Bivariable analyses and multivariable logistic regression were used to compare and analyze independent associations between patient and operative characteristics, POAF, and primary outcomes. Kaplan-Meier and the Cox proportional-hazards model were used to characterize long-term survival.
Results: The incidence of POAF was 37% (350/943). Median follow-up was 5 months (IQR 1-42 months). As expected, valve replacement (OR 2.9, p=0.004 95% CI 1.4-5.8) and increased age (OR 1.1, p<0.001 95% CI 1.0-1.1) were independently associated with POAF, whereas worsening heart failure was not (OR 1.2, p=0.4 95% 95% CI 0.8-1.6). Neurologic events occurred in 6% (21/350) of POAF, significantly higher than the 3% (18/593) in no-POAF (p=0.03). Although POAF itself did not impart a mortality risk, POAF was an independent risk factor for the development of new/recurrent AF after 30 days (OR 3.7, p<0.001 95% 2.5-5.5). Additionally, new/recurrent AF did independently increase risk of long-term mortality (HR 1.3, p=0.002, 95% CI 1.1-1.6). Ultimately, POAF patients had worse long-term survival (p=0.002) (Figure 1).
Conclusions: POAF increases the risk of neurologic events, portends development of new/recurrent AF and is associated with worse long-term survival. POAF is not benign and carries a long-term mortality implication. Further research into the cause, prevention and management of POAF is warranted. Patients should be carefully surveilled for the development of long-term AF.

Atrial Fibrillation in Mitral Valve Disease