Kohno Hiroki, Ueda Hideki, Matsuura Kaoru, Tamura Yusaku, Watanabe Michiko, Matsumiya Goro
Department of Cardiovascular Surgery, Chiba University Graduate School of Medicine, Chiba, Japan.
Asian Cardiovasc Thorac Ann. 2017 Mar;25(3):179-191. doi: 10.1177/0218492317689902. Epub 2017 Jan 11.
Background Atrial fibrillation is a common complication after cardiac surgery, but the risk factors and long-term outcome after primary isolated aortic valve replacement remains to be clarified. Methods A single-center retrospective study was conducted on 157 patients who underwent first-time isolated aortic valve replacement between April 1999 and February 2015. Fifty-eight patients developed new-onset atrial fibrillation within 6 months postoperatively, and they were compared with patients who remained in sinus rhythm. Multivariate analyses, which incorporated the propensity score patient matching technique, were conducted to evaluate the long-term outcome of new-onset postoperative atrial fibrillation and identify patients at risk of developing this arrhythmia. Results At a mean follow-up of 52.4 months (range 8.4-200.7 months), mortality was significantly higher in patients who developed atrial fibrillation compared to those who remained in sinus rhythm (2.8%/patient-year vs. 0.2%/patient-year, respectively; p < 0.05). Patients developing atrial fibrillation were also at an independently increased risk of stroke and readmission during follow-up. Risk analysis revealed that advanced age (>70 years) and absence of a postoperative β-blocker were predictors of atrial fibrillation. Conclusions New-onset atrial fibrillation after first-time isolated aortic valve replacement correlated significantly with late morbidity and mortality. Advanced age and absence of a postoperative β-blocker may increase the incidence of atrial fibrillation.
心房颤动是心脏手术后常见的并发症，但首次单纯主动脉瓣置换术后的危险因素和长期预后仍有待明确。方法：对1999年4月至2015年2月期间首次接受单纯主动脉瓣置换术的157例患者进行单中心回顾性研究。58例患者术后6个月内出现新发心房颤动，并与维持窦性心律的患者进行比较。采用倾向评分患者匹配技术进行多因素分析，以评估术后新发心房颤动的长期预后，并确定发生这种心律失常的风险患者。结果：平均随访52.4个月（范围8.4 - 200.7个月），发生心房颤动的患者死亡率显著高于维持窦性心律的患者（分别为2.8%/患者年和0.2%/患者年；p < 0.05）。发生心房颤动的患者在随访期间发生中风和再次入院的独立风险也增加。风险分析显示，高龄（>70岁）和术后未使用β受体阻滞剂是心房颤动的预测因素。结论：首次单纯主动脉瓣置换术后新发心房颤动与晚期发病率和死亡率显著相关。高龄和术后未使用β受体阻滞剂可能增加心房颤动的发生率。
