Department of Cardiothoracic Surgery, St. Vincent's Hospital Melbourne, Fitzroy, Victoria, Australia.
Ann Thorac Surg. 2013 Jan;95(1):133-40. doi: 10.1016/j.athoracsur.2012.08.077. Epub 2012 Nov 28.
Several studies have shown that postoperative atrial fibrillation (POAF) is associated with poorer short-term and long-term outcomes after general cardiac operations. There is, however, a paucity of data on the impact of POAF on outcomes after isolated aortic valve replacement (AVR).
Data for all patients undergoing isolated first-time AVR between June 2001 and December 2009 was obtained from the Australasian Society of Cardiac and Thoracic Surgeons (ASCTS) National Cardiac Surgery Database Program and a retrospective analysis was conducted. Preoperative characteristics, early postoperative outcome, and late survival were compared between patients in whom POAF developed and those in whom it did not. Propensity score matching was performed to correct for differences between the 2 groups.
Excluding patients with preoperative arrhythmia, isolated first-time AVR was performed in 2,065 patients. POAF developed in 725 (35.1%) of them. Patients with POAF were significantly older (mean age, 72 versus 65 years; p < 0.001) and presented more often with comorbidities, including hypertension, respiratory disease, and hypercholesterolemia (all p < 0.05). From the initial study population, 592 propensity-matched patient pairs were derived; the overall matching rate was 81.7%. In the matched groups, 30-day mortality was not significantly different between the POAF and non-POAF groups (1.5% versus 1%; p = 0.48). Patients with POAF were, however, at an independently increased risk of perioperative complications, including new renal failure, gastrointestinal complications, and 30-day readmission (p < 0.05). Seven-year mortality was not significantly different between POAF and non-POAF groups (78% versus 83%; p = 0.63).
POAF is a risk factor for short-term morbidity but is not associated with a higher rate of early or late mortality after isolated AVR.
多项研究表明，术后心房颤动（POAF）与心脏手术的短期和长期预后较差有关。然而，关于 POAF 对孤立主动脉瓣置换（AVR）术后结果的影响的数据却很少。
从澳大利亚心胸外科协会（ASCTS）国家心脏手术数据库计划中获取了 2001 年 6 月至 2009 年 12 月期间所有接受首次孤立 AVR 的患者的数据，并进行了回顾性分析。比较了 POAF 组和非 POAF 组患者的术前特征、术后早期结果和晚期生存率。采用倾向评分匹配法校正两组间的差异。
排除术前心律失常的患者，共有 2065 例患者接受了孤立的首次 AVR。其中 725 例（35.1%）发生 POAF。POAF 患者年龄明显较大（平均年龄 72 岁比 65 岁；p < 0.001），更常伴有合并症，包括高血压、呼吸系统疾病和高胆固醇血症（均 p < 0.05）。从最初的研究人群中，得出了 592 对倾向评分匹配的患者对；总体匹配率为 81.7%。在匹配组中，POAF 组和非 POAF 组 30 天死亡率无显著差异（1.5%比 1%；p = 0.48）。然而，POAF 患者围手术期并发症的风险独立增加，包括新发肾衰竭、胃肠道并发症和 30 天再入院（p < 0.05）。POAF 组和非 POAF 组 7 年死亡率无显著差异（78%比 83%；p = 0.63）。
POAF 是短期发病率的危险因素，但与孤立 AVR 后早期或晚期死亡率的增加无关。
