Department of Surgery and Physiology, Faculty of Medicine, University of Porto, Portugal.
São João University Hospital Center, Porto, Portugal.
Ann Thorac Cardiovasc Surg. 2020 Dec 20;26(6):342-351. doi: 10.5761/atcs.oa.19-00314. Epub 2020 Apr 28.
Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women.
This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan-Meier (KM) to determine the impact of POAF in long-term mortality according to gender.
Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68-0.86] and 0.69 [0.60-0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women.
In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.
冠状动脉旁路移植术（CABG）后发生的心房颤动（POAF）与女性死亡风险增加相关，但与男性无关。我们旨在探讨男性和女性单纯主动脉瓣置换术（AVR）后 POAF 的预测因素和长期死亡率。
本研究纳入了 379 例无先前心房颤动（AF）的严重主动脉瓣狭窄患者，他们接受了单纯的 AVR 手术。我们使用多因素逻辑回归分析来探讨新发 POAF 的独立性别预测因素，并通过 Kaplan-Meier（KM）分析来确定 POAF 对男性和女性长期死亡率的影响。
POAF 患者在两性中均具有较高的年龄和冠心病患病率。多因素分析显示，术后峰值乳酸增加与男性 POAF 独立相关，而女性的平均主动脉瓣梯度较低与 POAF 相关。该模型的曲线下面积（AUC）在男性和女性中分别为 0.77[0.68-0.86]和 0.69[0.60-0.78]。在 4 年随访期间，POAF 与男性死亡风险增加相关，但与女性无关。
在严重主动脉瓣狭窄中，与 POAF 相关的因素及其对死亡率的影响在性别之间存在差异，仅在男性中观察到死亡风险增加。
