PMID- 20172119
OWN - NLM
STAT- MEDLINE
DCOM- 20100316
LR  - 20100222
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 89
IP  - 3
DP  - 2010 Mar
TI  - Chronic atrial fibrillation is associated with reduced survival after aortic and 
      double valve replacement.
PG  - 738-44
LID - 10.1016/j.athoracsur.2009.12.023 [doi]
AB  - 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.
CI  - 2010 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights 
      reserved.
FAU - Schulenberg, Richard
AU  - Schulenberg R
AD  - Department of Cardiac Surgery, Oxford Heart Centre, John Radcliffe Hospital, 
      Oxford, United Kingdom.
FAU - Antonitsis, Polychronis
AU  - Antonitsis P
FAU - Stroebel, Andrie
AU  - Stroebel A
FAU - Westaby, Stephen
AU  - Westaby S
LA  - eng
PT  - Journal Article
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Aortic Valve/*surgery
MH  - Atrial Fibrillation/*complications
MH  - Chronic Disease
MH  - Coronary Artery Bypass
MH  - Female
MH  - Heart Valve Diseases/complications
MH  - Heart Valve Prosthesis Implantation/*mortality
MH  - Hospital Mortality
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Mitral Valve/*surgery
MH  - Risk Factors
MH  - Survival Analysis
MH  - Survival Rate
MH  - Young Adult
EDAT- 2010/02/23 06:00
MHDA- 2010/03/17 06:00
CRDT- 2010/02/23 06:00
PHST- 2009/10/12 00:00 [received]
PHST- 2009/12/07 00:00 [revised]
PHST- 2009/12/09 00:00 [accepted]
PHST- 2010/02/23 06:00 [entrez]
PHST- 2010/02/23 06:00 [pubmed]
PHST- 2010/03/17 06:00 [medline]
AID - S0003-4975(09)02559-4 [pii]
AID - 10.1016/j.athoracsur.2009.12.023 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2010 Mar;89(3):738-44. doi: 10.1016/j.athoracsur.2009.12.023.