Cardiovascular Research Foundation, New York, New York, USA.
Division of Cardiac Surgery, Northwestern University, Chicago, Illinois, USA.
JACC Cardiovasc Interv. 2021 Jul 26;14(14):1565-1574. doi: 10.1016/j.jcin.2021.05.026.
The aim of this study was to assess the incidence and prognostic impact of early and late postoperative atrial fibrillation or flutter (POAF) in patients with severe aortic stenosis (AS) treated with transcatheter aortic valve replacement (TAVR) or surgical aortic valve replacement (SAVR).
There is an ongoing controversy regarding the incidence, recurrence rate, and prognostic impact of early (in-hospital) POAF and late (postdischarge) POAF in patients with AS undergoing TAVR or SAVR.
In the PARTNER (Placement of Aortic Transcatheter Valve) 3 trial, patients with severe AS at low surgical risk were randomized to TAVR or SAVR. Analyses were performed in the as-treated population excluding patients with preexistent atrial fibrillation or flutter.
Among 781 patients included in the analysis, early POAF occurred in 152 (19.5%) (18 of 415 [4.3%] and 134 of 366 [36.6%] following TAVR and SAVR, respectively). Following discharge, 58 new or recurrent late POAF events occurred within 1 year following the index procedure in 55 of 781 patients (7.0%). Early POAF was not an independent predictor of late POAF following discharge (odds ratio: 1.04; 95% CI: 0.52-2.08; P = 0.90). Following adjustment, early POAF was not an independent predictor of the composite outcome of death, stroke, or rehospitalization (hazard ratio: 1.10; 95% CI: 0.64-1.92; P = 0.72), whereas late POAF was associated with an increased adjusted risk for the composite outcome (hazard ratio: 8.90; 95% CI: 5.02-15.74; P < 0.0001), irrespective of treatment modality.
In the PARTNER 3 trial, early POAF was more frequent following SAVR compared with TAVR. Late POAF, but not early POAF, was significantly associated with worse outcomes at 2 years, irrespective of treatment modality.
本研究旨在评估经导管主动脉瓣置换术（TAVR）或外科主动脉瓣置换术（SAVR）治疗重度主动脉瓣狭窄（AS）患者的早期和晚期术后心房颤动或扑动（POAF）的发生率和预后影响。
关于接受 TAVR 或 SAVR 的 AS 患者中早期（住院期间）POAF 和晚期（出院后）POAF 的发生率、复发率和预后影响仍存在争议。
在 PARTNER 3 试验中，低手术风险的重度 AS 患者被随机分配接受 TAVR 或 SAVR。在排除了术前存在心房颤动或扑动的患者后，对按治疗情况进行分析。
在纳入分析的 781 例患者中，152 例（19.5%）发生早期 POAF（415 例中有 18 例[4.3%]，366 例中有 134 例[36.6%]）。出院后，781 例患者中有 55 例（7.0%）在索引手术后 1 年内出现 58 例新发或复发性晚期 POAF 事件。早期 POAF 并不是出院后晚期 POAF的独立预测因素（比值比：1.04；95%CI：0.52-2.08；P=0.90）。调整后，早期 POAF 不是死亡、卒中和再住院复合结局的独立预测因素（风险比：1.10；95%CI：0.64-1.92；P=0.72），而晚期 POAF 与调整后复合结局风险增加相关（风险比：8.90；95%CI：5.02-15.74；P<0.0001），与治疗方式无关。
在 PARTNER 3 试验中，SAVR 后早期 POAF 比 TAVR 更常见。晚期 POAF 与 2 年时的不良结局显著相关，而早期 POAF 则没有，且与治疗方式无关。
