Chronic atrial fibrillation is associated with reduced survival after aortic and double valve replacement

Abstract

Background: Although chronic atrial fibrillation (AF) is thought to negatively affect survival after aortic valve replacement (AVR), evidence is limited and intraoperative methods to restore sinus rhythm are not widely adopted. This study investigated long-term outcome in valve prosthesis patients with or without AF.

Methods: Between 1994 and 2006, 420 patients with the same mechanical prosthesis were prospectively entered into a database; 90 had chronic AF preoperatively. Medical therapy was used to attempt to restore sinus rhythm postoperatively, but none had intraoperative ablation. All were anticoagulated with warfarin and monitored serially in National Health Service (United Kingdom) clinics. Survival and adverse events were determined by detailed review.

Results: Mean follow-up was 79.5 months (range, 18 months to 13.5 years); 12 were lost to follow-up. Procedures included 225 AVRs with or without coronary bypass (AVR with CABG), 151 mitral valve replacements (MVR) with CABG, and 32 double-valve replacements (DVR). Preoperative AF patients remained in the same rhythm 6 months postoperatively. Prosthesis-related events were infrequent. For chronic AF patients, mortality at 10 years was greater after AVR (64.3% vs 19.2% p < 0.001), AVR with CABG (83.3% vs 21.3% p < 0.001), and DVR (80.0% vs 17.6% p < 0.001). Survival after isolated MVR or MVR with CABG (p > 0.05) was similar. Most MVR with CABG patients in sinus rhythm had acute ischemic mitral regurgitation. Greater age (p = 0.001) and preoperative AF (p = 0.02) were risk factors for death.

Conclusions: Chronic AF negatively affects survival after AVR with or without CABG and DVR with a mechanical prosthesis. Prospective randomized evaluation of AF ablation is suggested for these patients.