Isolated Postoperative Atrial Fibrillation after Thoracic Aortic Aneurysm Repair Does Not Reduce Long-term Survival
Presented During:
Thursday, April 25, 2024: 5:38PM - 7:00PM
Sheraton Times Square
Posted Room Name:
Central Park
Abstract No:
P0185
Submission Type:
Abstract Submission
Authors:
Megan Chung (1), Cheryl Pan (1), Hideyuki Hayashi (1), Viswajit Kandula (1), Yanling Zhao (1), Dov Levine (1), Patra Childress (1), Lauren Sutherland (1), Syed Raza (1), Paul Kurlansky, MD (1), Craig Smith (1), Hiroo Takayama (1)
Institutions:
(1) Columbia University Irving Medical Center, New York, NY
Submitting Author:
Megan Chung
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Co-Author(s):
Cheryl Pan
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Hideyuki Hayashi
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Viswajit Kandula
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Yanling Zhao
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Dov Levine
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Patra Childress
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Lauren Sutherland
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Syed Raza
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
*Paul Kurlansky, MD
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
*Craig Smith
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
*Hiroo Takayama
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Presenting Author:
Megan Chung
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Columbia University Irving Medical Center
Columbia University Irving Medical Center
Abstract:
Objective: While postoperative atrial fibrillation (POAF) has been shown to be associated with worse survival after cardiac surgery, its effect on outcomes independent from other postoperative complications after thoracic aortic aneurysm repair is not well understood.
Methods: This is a single-center retrospective study of patients who underwent thoracic aortic aneurysm repair between March 2005 and March 2021. POAF was defined as new-onset atrial fibrillation (AF) that developed during the index hospital stay. Postoperative complications included reoperation for bleeding, respiratory failure, acute renal failure, and stroke. Factors associated with POAF were identified with multivariable regression. In patients without postoperative complications, propensity score matching for baseline and intraoperative characteristics was used to create well-matched groups of patients with and without POAF. Long-term survival was analyzed by the method of Kaplan and Meier and compared using the log rank test. Factors associated with 10-year survival were assessed using Cox regression.
Results: Of 1,454 patients, 520 (35.8%) had POAF. Patients with POAF had a higher rate of postoperative complications than those without AF (20.2% vs. 12.2%, p<0.001). Multivariable logistic regression revealed that age (OR 1.05, p<0.001), lowest body temperature (OR 1.06, p=0.001), intra-aortic balloon pump use (OR 22.5, p=0.004), and postoperative complications (OR 1.63, p=0.003) were independently associated with POAF. On a median of 7.1 year follow-up, unadjusted 10-year survival was lower in patients with POAF (82.0% [95% CI: 78.0%-86.1%] vs. 87.0% [84.4%-89.8%], p=0.008) (Figure A). In the matched cohort of patients without postoperative complications, 10-year survival was similar between patients with (83.6% [79.3%-88.2%]) and without POAF (83.8% [79.4%-88.6%], p=0.75) (Figure B). Postoperative complications but not POAF were independently associated with 10-year mortality on multivariable cox regression together with age, chronic obstructive pulmonary disease, peripheral vascular disease, prior myocardial infarction, preoperative ejection fraction, and use of circulatory arrest.
Conclusions: POAF is common after open proximal thoracic aortic aneurysm repair. Patients with POAF have higher rates of postoperative complications than patients without AF; however, patients with POAF in the absence of other major complications have equivalent long-term survival when compared to patients who do not have POAF. This data could suggest that POAF may be a marker of overall sickness rather than an independent contributor to mortality and morbidity.
Methods: This is a single-center retrospective study of patients who underwent thoracic aortic aneurysm repair between March 2005 and March 2021. POAF was defined as new-onset atrial fibrillation (AF) that developed during the index hospital stay. Postoperative complications included reoperation for bleeding, respiratory failure, acute renal failure, and stroke. Factors associated with POAF were identified with multivariable regression. In patients without postoperative complications, propensity score matching for baseline and intraoperative characteristics was used to create well-matched groups of patients with and without POAF. Long-term survival was analyzed by the method of Kaplan and Meier and compared using the log rank test. Factors associated with 10-year survival were assessed using Cox regression.
Results: Of 1,454 patients, 520 (35.8%) had POAF. Patients with POAF had a higher rate of postoperative complications than those without AF (20.2% vs. 12.2%, p<0.001). Multivariable logistic regression revealed that age (OR 1.05, p<0.001), lowest body temperature (OR 1.06, p=0.001), intra-aortic balloon pump use (OR 22.5, p=0.004), and postoperative complications (OR 1.63, p=0.003) were independently associated with POAF. On a median of 7.1 year follow-up, unadjusted 10-year survival was lower in patients with POAF (82.0% [95% CI: 78.0%-86.1%] vs. 87.0% [84.4%-89.8%], p=0.008) (Figure A). In the matched cohort of patients without postoperative complications, 10-year survival was similar between patients with (83.6% [79.3%-88.2%]) and without POAF (83.8% [79.4%-88.6%], p=0.75) (Figure B). Postoperative complications but not POAF were independently associated with 10-year mortality on multivariable cox regression together with age, chronic obstructive pulmonary disease, peripheral vascular disease, prior myocardial infarction, preoperative ejection fraction, and use of circulatory arrest.
Conclusions: POAF is common after open proximal thoracic aortic aneurysm repair. Patients with POAF have higher rates of postoperative complications than patients without AF; however, patients with POAF in the absence of other major complications have equivalent long-term survival when compared to patients who do not have POAF. This data could suggest that POAF may be a marker of overall sickness rather than an independent contributor to mortality and morbidity.
Aortic Symposium:
Anesthesia and Perioperative Management
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