主动脉瓣置换术后的术后房颤是长期房颤的一个危险因素。
Postoperative atrial fibrillation after aortic valve replacement is a risk factor for long-term atrial fibrillation.
作者信息
Carter-Storch Rasmus, Dahl Jordi S, Christensen Nicolaj L, Pecini Redi, Søndergård Eva V, Øvrehus Kristian Altern, Møller Jacob E
机构信息
Department of Cardiology, Odense University Hospital, Odense, Denmark.
OPEN Odense Patient Data Explorative Network.
出版信息
Interact Cardiovasc Thorac Surg. 2019 Sep 1;29(3):378-385. doi: 10.1093/icvts/ivz094.
OBJECTIVES
Postoperative atrial fibrillation (POAF) is a common complication following cardiac surgery. However, knowledge on the rate of long-term atrial fibrillation (LTAF) after POAF remains unclear. We investigated predictors of POAF in patients with aortic stenosis undergoing surgical aortic valve replacement, and assessed the rate of LTAF during follow-up.
METHODS
We prospectively included 96 adult patients with severe aortic stenosis undergoing surgical aortic valve replacement. Patients with previous atrial fibrillation (AF) were excluded. Patients underwent echocardiography, cardiac computed tomography and magnetic resonance imaging immediately prior to surgery. Surgical aortic clamp time and postoperative C-reactive protein (CRP) were documented. POAF was defined as AF recorded within 7 days of surgery. Through chart review, patients were followed up for documented episodes of LTAF occurring more than 7 days after surgery.
RESULTS
POAF occurred in 51 patients (53%). It was associated with larger preoperative echocardiographic left atrial volume index (44 ± 12 vs 37 ± 8 ml/m2, P = 0.004), longer aortic clamp time [80 (70-102) vs 72 (62-65) min, P = 0.04] and higher CRP on first postoperative day [80 (64-87) vs 65 (44-83) mg/l, P = 0.001]. Multivariable logistic regression revealed that left atrial volume index [odds ratio (OR) 1.07, 95% confidence interval (CI) 1.02-1.13; P = 0.005] and postoperative CRP (OR 1.03, 95% CI 1.01-1.05; P = 0.006) were the only independent predictors of POAF. During 695 days (25th-75th percentile: 498-859 days) of follow-up, LTAF occurred in 11 patients of whom 10 were in the POAF group (hazard ratio 9.4, 95% CI 1.2-74; P = 0.03).
CONCLUSIONS
POAF is predicted by left atrial volume index and postoperative CRP. Patients with POAF have a 9-fold increase risk of developing symptomatic LTAF during follow-up.
CLINICAL TRIAL REGISTRATION NUMBER
ClinicalTrials.gov (NCT02316587).
目的
术后房颤（POAF）是心脏手术后常见的并发症。然而，关于POAF后长期房颤（LTAF）发生率的相关知识仍不明确。我们研究了接受外科主动脉瓣置换术的主动脉瓣狭窄患者发生POAF的预测因素，并评估了随访期间LTAF的发生率。
方法
我们前瞻性纳入了96例接受外科主动脉瓣置换术的重度主动脉瓣狭窄成年患者。排除既往有房颤（AF）的患者。患者在手术前立即接受超声心动图、心脏计算机断层扫描和磁共振成像检查。记录手术主动脉阻断时间和术后C反应蛋白（CRP）。POAF定义为术后7天内记录到的房颤。通过查阅病历，对患者进行随访，记录术后7天以上发生的LTAF事件。
结果
51例患者（53%）发生POAF。它与术前超声心动图测得的较大左心房容积指数相关（44±12 vs 37±8 ml/m2，P = 0.004）、较长的主动脉阻断时间[80（70 - 102）vs 72（62 - 65）分钟，P = 0.04]以及术后第1天较高的CRP水平[80（64 - 87）vs 65（44 - 83）mg/l，P = 0.001]。多变量逻辑回归显示，左心房容积指数[比值比（OR）1.07，95%置信区间（CI）1.02 - 1.13；P = 0.005]和术后CRP（OR 1.03，95% CI 1.01 - 1.05；P = 0.006）是POAF仅有的独立预测因素。在695天（第25 - 75百分位数：498 - 859天）的随访期间，11例患者发生LTAF，其中10例在POAF组（风险比9.4，95% CI 1.2 - 74；P = 0.03）。
结论
左心房容积指数和术后CRP可预测POAF。POAF患者在随访期间发生有症状LTAF的风险增加9倍。
临床试验注册号
ClinicalTrials.gov（NCT02316587）。
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