Department of Vascular Surgery Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
Cardiac Arrhythmia Center Fuwai HospitalState Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular DiseasesChinese Academy of Medical Sciences and Peking Union Medical College Beijing China.
J Am Heart Assoc. 2021 Sep 21;10(18):e021980. doi: 10.1161/JAHA.121.021980. Epub 2021 Sep 17.
Background It is well established that postoperative atrial fibrillation (POAF) is associated with adverse postoperative outcomes after major cardiac operations. The purpose of this study was to investigate the incidence of new-onset POAF after successful total arch repair surgery and the association between POAF and in-hospital mortality. Methods and Results All consecutive patients undergoing total arch repair from September 2012 to December 2019 in Fuwai hospital were enrolled (n=1280). Patients diagnosed with preoperative atrial fibrillation were excluded. POAF was diagnosed as the new-onset atrial fibrillation or flutter for more than 5 minutes based on continuous electrocardiogram monitoring. A logistic regression model was used to determine predictors of in-hospital mortality. Multivariable adjustment, inverse probability of treatment weighting, and propensity score matching were used to adjust for confounders. POAF was diagnosed in 32.3% (411/1271) of this cohort population. The occurrence of new-onset POAF was associated with age (odds ratio [OR], 1.05; 95% CI, 1.04-1.06; <0.001), male sex (OR, 0.72; 95% CI, 0.52-0.98; =0.035), and surgery duration (OR, 1.2; 95% CI, 1.12-1.28; <0.001). The in-hospital mortality was significantly higher in patients with POAF than those without POAF (10.7% versus 2.4%, <0.001). Inverse probability of treatment weighting and propensity score matching analyses confirmed the results. The increased in-hospital mortality in POAF group still existed among subgroup analysis based on different age, sex, hypertension, smoking, and hypokalemia, combined with cardiac surgery, and deep hypothermic circulatory arrest. Conclusions More careful attention should be given to POAF after total arch repair surgery. The incidence of POAF after total arch repair surgery was 32.3% and associated with increased in-hospital mortality. The elderly female patient who experienced longer operation duration was at highest risk for POAF.
术后心房颤动（POAF）与大型心脏手术后的不良术后结局密切相关。本研究旨在探讨全弓修复术后新发 POAF 的发生率以及 POAF 与院内死亡率之间的关系。
纳入 2012 年 9 月至 2019 年 12 月在阜外医院接受全弓修复术的所有连续患者（n=1280）。排除术前诊断为心房颤动的患者。POAF 的诊断标准为基于连续心电图监测 5 分钟以上的新发心房颤动或扑动。使用逻辑回归模型确定院内死亡率的预测因素。使用多变量调整、逆概率处理加权和倾向评分匹配来调整混杂因素。在该队列人群中，32.3%（411/1271）诊断为新发 POAF。新发 POAF 的发生与年龄（比值比[OR]，1.05；95%CI，1.04-1.06；<0.001）、男性（OR，0.72；95%CI，0.52-0.98；=0.035）和手术时间（OR，1.2；95%CI，1.12-1.28；<0.001）相关。POAF 患者的院内死亡率明显高于无 POAF 患者（10.7%对 2.4%，<0.001）。逆概率处理加权和倾向评分匹配分析证实了这一结果。在基于不同年龄、性别、高血压、吸烟和低钾血症、联合心脏手术和深低温循环停搏的亚组分析中，POAF 组的院内死亡率增加仍然存在。
全弓修复术后应更加关注 POAF。全弓修复术后 POAF 的发生率为 32.3%，与院内死亡率增加相关。经历较长手术时间的老年女性患者发生 POAF 的风险最高。
