Ngaage Dumbor L, Schaff Hartzell V, Barnes Sunni A, Sundt Thoralf M, Mullany Charles J, Dearani Joseph A, Daly Richard C, Orszulak Thomas A
Division of Cardiovascular Surgery, Mayo Medical Center, Rochester, Minnesota, USA.
Ann Thorac Surg. 2006 Oct;82(4):1392-9. doi: 10.1016/j.athoracsur.2006.04.004.
The prognostic significance of preoperative atrial fibrillation (AF) at the time of aortic valve replacement is unknown, as is the potential role for concomitant arrhythmia surgery.
We performed a cohort comparison of patients with preoperative AF (n = 129) and preoperative sinus rhythm (SR, n = 252) undergoing aortic valve surgery between 1993 and 2002; patients were matched for age, gender, and left ventricular ejection fraction. Follow-up (mean interval, 4.5 years) was 98% complete. Primary endpoints were late cardiac and all-cause mortality, as well as major adverse cardiac or cerebrovascular event.
Patients with preoperative AF presented with more severe congestive heart failure (p = 0.03) and more often had significant tricuspid regurgitation (p = 0.01) preoperatively. They also had worse late survival (risk ratio [RR] for death = 1.5, p = 0.03) with 1-, 5-, and 7-year survival rates substantially reduced at 94%, 87%, and 50%, respectively, for those in AF versus 98%, 90%, and 61% for patients in sinus rhythm preoperatively. Individuals in AF had a greater probability of subsequent rhythm-related intervention (RR = 4.7, p = 0.0002), and more frequently developed congestive heart failure (25% vs 10%, p = 0.005) and stroke (16% vs 5%, p = 0.005). By multivariable analysis, preoperative AF was an independent predictor of late adverse cardiac and cerebrovascular events, but not late death.
Performance of concomitant arrhythmia surgery in patients undergoing aortic valve surgery may reduce late morbidity; however, its potential impact on late mortality in this high-risk subset of patients remains unclear.
主动脉瓣置换时术前房颤（AF）的预后意义尚不清楚，同时进行心律失常手术的潜在作用也不明确。
我们对1993年至2002年间接受主动脉瓣手术的术前房颤患者（n = 129）和术前窦性心律（SR，n = 252）患者进行了队列比较；患者在年龄、性别和左心室射血分数方面进行了匹配。随访（平均间隔4.5年）完成率为98%。主要终点是晚期心脏和全因死亡率，以及主要不良心脏或脑血管事件。
术前房颤患者术前出现更严重的充血性心力衰竭（p = 0.03），且更常出现明显的三尖瓣反流（p = 0.01）。他们的晚期生存率也更差（死亡风险比[RR]=1.5，p = 0.03），房颤患者的1年、5年和7年生存率分别大幅降低至94%、87%和50%，而术前窦性心律患者分别为98%、90%和61%。房颤患者随后进行节律相关干预的可能性更大（RR = 4.7，p = 0.0002），并且更频繁地发生充血性心力衰竭（25%对10%，p = 0.005）和中风（16%对5%，p = 0.005）。通过多变量分析，术前房颤是晚期不良心脏和脑血管事件的独立预测因素，但不是晚期死亡的独立预测因素。
在接受主动脉瓣手术的患者中进行心律失常手术可能会降低晚期发病率；然而，其对这一高危患者亚组晚期死亡率的潜在影响仍不清楚。
