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Catheter Ablation in Combination With Left Atrial Appendage Closure for Atrial Fibrillation
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Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery

Hyo-Hyun Kim1, Ji-Hong Kim1, Sak Lee1

  • 1Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea.

Journal of Chest Surgery
|July 13, 2022
PubMed

Insights

Preoperative atrial fibrillation (Afib) increases mortality risk after cardiac surgery. However, performing Cox-maze surgery concurrently with cardiac procedures may improve survival rates for Afib patients.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Epidemiology

Background:

  • Atrial fibrillation (Afib) is a significant predictor of cardiovascular complications.
  • Afib is prevalent in patients undergoing cardiac surgery, necessitating an understanding of its impact on outcomes.
  • Assessing the effect of preoperative Afib on postsurgical results is crucial.

Purpose of the Study:

  • To investigate the association between preoperative atrial fibrillation and clinical outcomes in patients undergoing cardiac surgery.
  • To analyze the impact of Afib on mortality and other adverse events post-cardiac surgery.
  • To evaluate the potential benefit of specific surgical interventions, like Cox-maze surgery, in mitigating Afib-related risks.

Main Methods:

  • Retrospective cohort study utilizing the Korean National Health Insurance Service database (2009-2015).
  • Inclusion of 1,022 patients who underwent cardiac surgery, with analysis of preoperative atrial fibrillation status.
  • Statistical analysis including hazard ratios and confidence intervals to determine risk associations.

Main Results:

  • Preoperative atrial fibrillation was linked to increased patient mortality (p=0.028) irrespective of surgical procedure.
  • Patients with preoperative Afib (18.6%) faced a higher cumulative risk of overall mortality (HR, 1.435; p=0.034).
  • Cox-maze surgery demonstrated a reduced risk of overall mortality in Afib patients (HR, 0.500; p=0.031), while postoperative cerebral events were not associated with Afib.

Conclusions:

  • Preoperative atrial fibrillation is an independent predictor of poorer long-term outcomes following cardiac surgery.
  • Concurrent Cox-maze surgery may enhance survival rates in patients with atrial fibrillation undergoing cardiac procedures.
  • Further research may explore optimized surgical strategies for Afib patients.
Abstract

Keywords:
Atrial fibrillationDatabaseMaze procedure

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