Article

Prognostic value of preoperative atrial fibrillation in patients with aortic stenosis and low ejection fraction having aortic valve replacement.

INSERM, ERI-12, University Hospital, Amiens, France.
The American Journal of Cardiology (impact factor: 3.37). 09/2006; 98(6):809-11. DOI:10.1016/j.amjcard.2006.03.067 pp.809-11
Source: PubMed

ABSTRACT Aortic valve replacement in severe aortic stenosis (AS) with a low left ventricular ejection fraction (EF) is associated with high perioperative mortality. The aim of this study was to assess the prognostic value of preoperative atrial fibrillation (AF) in patients with AS and low EFs who undergo aortic valve replacement. Eighty-three consecutive patients with severe AS (area <1 cm2) and low EFs (< or =35%) were prospectively included. Perioperative mortality was 12%. Twenty-nine patients (35%) had preexisting paroxysmal or permanent AF. Perioperative mortality was higher in the AF group than in the non-AF group (24% vs 5.5%, p = 0.03). Preoperative AF was identified as an independent predictor of perioperative mortality (odds ratio 7.5, 95% confidence interval 1.19 to 47.06, p = 0.03). Five-year overall survival was lower in the AF group than in the non-AF group (47% vs 77%, p = 0.0017). Associated multivessel coronary artery disease and preoperative AF were identified as 2 independent predictors of overall mortality. In conclusion, in patients with AS with low left ventricular EFs, preoperative AF is associated with higher operative risk and lower postoperative survival. The presence of AF in patients with severe AS and low EFs should be taken into account for operative risk stratification, along with low pressure gradient and associated multivessel coronary artery disease.

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    Article: Concomitant ablation of atrial fibrillation in octogenarians: an observational study.
    Herko Grubitzsch, Sven Beholz, Pascal M Dohmen, Simon Dushe, Wolfgang Konertz
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    ABSTRACT: Cardiac surgery is increasingly required in octogenarians. These patients frequently present atrial fibrillation (AF), a significant factor for stroke and premature death. During the last decade, AF ablation has become an effective procedure in cardiac surgery. Because the results of concomitant AF ablation in octogenarians undergoing cardiac surgery are still not clear, we evaluated the outcome in these patients. Among 200 patients undergoing concomitant AF ablation (87% persistent AF), 28 patients were >/= 80 years (82 +/- 2.4 years). The outcome was analysed by prospective follow up after 3, 6, 12 months and annually thereafter. Freedom from AF was calculated according to the Kaplan-Meier method. Octogenarians were similar to controls regarding AF duration (48 +/- 63.2 versus 63 +/- 86.3 months, n.s.) and left atrial diameter (49 +/- 6.1 versus 49 +/- 8.8 mm, n.s.), but differed in EuroSCORE (17.3 +/- 10.93 versus 7.4 +/- 7.31%, p < 0.001), prevalence of paroxysmal AF (25.0 versus 11.0%, p = 0.042) and aortic valve disease (67.8 versus 28.5%, p < 0.001). ICU stay (8 +/- 16.9 versus 4 +/- 7.2 days, p = 0.027), hospital stay (20 +/- 23.9 versus 14 +/- 30.8 days, p < 0.05), and 30-d-mortality (14.3 versus 4.6%, p = 0.046) were increased. After 12 +/- 6.1 months of follow-up (95% complete), 14 octogenarians (82%) and 101 controls (68%, n.s.) were in sinus rhythm; 59% without antiarrhythmic drugs in either group (n.s.). Sinus rhythm restoration was associated with improved NYHA functional class and renormalization of left atrial size. Cumulative freedom from AF demonstrated no difference between groups. Late mortality was higher in octogenarians (16.7 versus 6.1%, p = 0.065). Sinus rhythm restoration rate and functional improvement are satisfactory in octogenarians undergoing concomitant AF ablation. Hence, despite an increased perioperative risk, this procedure should be considered even in advanced age.
    Journal of Cardiothoracic Surgery 02/2008; 3:21. · 1.19 Impact Factor
Data provided are for informational purposes only. Although carefully collected, accuracy cannot be guaranteed. The impact factor represents a rough estimation of the journal's impact factor and does not reflect the actual current impact factor. Publisher conditions are provided by RoMEO. Differing provisions from the publisher's actual policy or licence agreement may be applicable.

Keywords

2 independent predictors
 
AF group
 
Aortic valve replacement
 
consecutive patients
 
higher operative risk
 
independent predictor
 
low EFs
 
low pressure gradient
 
lower postoperative survival
 
multivessel coronary artery disease
 
odds ratio 7.5
 
operative risk stratification
 
perioperative mortality
 
permanent AF
 
preoperative AF
 
preoperative atrial fibrillation
 
prognostic value
 
severe aortic stenosis
 
ventricular EFs
 
ventricular ejection fraction