Beaulieu-Jones Brendin R, Lin Brenda, Phillips Annette M, Haime Miguel, Quin Jacquelyn A
Department of Surgery, Boston Medical Center, Boston, Massachusetts; VA Boston Healthcare System, West Roxbury, Massachusetts.
VA Boston Healthcare System, West Roxbury, Massachusetts.
J Surg Res. 2023 Nov;291:195-203. doi: 10.1016/j.jss.2023.05.027. Epub 2023 Jul 11.
The association between amiodarone treatment for postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) and both the return to normal sinus rhythm (NSR) and anticoagulation use at discharge has not been extensively studied.
We retrospectively identified all patients who underwent biological SAVR with or without concomitant coronary artery bypass grafting (CABG) at a Veterans Affairs Medical Center (2005-2015). We reviewed new-onset POAF, amiodarone use, return to NSR, and anticoagulation use with warfarin. Discharge rhythm and warfarin administration were compared among patients with POAF who were treated with amiodarone and patients who did not receive amiodarone.
Of the 395 patients (186 AVR/coronary artery bypass grafting; 209 AVR) studied, POAF developed in 191 patients (48.0%); 80.1% (153/191) of these patients received amiodarone. Among patients treated with amiodarone, 70.6% (108/153) were in SR at the time of discharge versus 65.8% (25/38) of POAF patients who were not treated with amiodarone (P = 0.57). Among amiodarone-treated patients, 30.7% (47/153) were discharged with warfarin; among patients not treated with amiodarone, 31.6% (12/38) were discharged with warfarin (P = 0.92). Among amiodarone-treated patients discharged in NSR, 89.9% (97/108 patients) were not discharged with warfarin; among patients not treated with amiodarone who were discharged in NSR, 92% (23/25) were not discharged with warfarin (P = 0.74).
POAF after SAVR appears common. Although amiodarone is often used for POAF patients, its use does not appear to be associated with surgeons' decision to anticoagulate patients. Surgeons' preferences for using rhythm control and antithrombotic therapy for POAF after SAVR warrant further exploration.
外科主动脉瓣置换术（SAVR）后使用胺碘酮治疗术后房颤（POAF）与恢复正常窦性心律（NSR）及出院时抗凝药物的使用之间的关联尚未得到广泛研究。
我们回顾性确定了在一家退伍军人事务医疗中心（2005 - 2015年）接受生物SAVR且有或无同期冠状动脉旁路移植术（CABG）的所有患者。我们回顾了新发POAF、胺碘酮的使用、恢复NSR以及华法林的抗凝使用情况。比较了接受胺碘酮治疗的POAF患者和未接受胺碘酮治疗的患者的出院心律及华法林给药情况。
在研究的395例患者（186例AVR/冠状动脉旁路移植术；209例AVR）中，191例患者（48.0%）发生了POAF；这些患者中有80.1%（153/191）接受了胺碘酮治疗。在接受胺碘酮治疗的患者中，70.6%（108/153）在出院时处于窦性心律，而未接受胺碘酮治疗的POAF患者中这一比例为65.8%（25/38）（P = 0.57）。在接受胺碘酮治疗的患者中，30.7%（47/153）出院时使用华法林；在未接受胺碘酮治疗的患者中，31.6%（12/38）出院时使用华法林（P = 0.92）。在以NSR出院的接受胺碘酮治疗的患者中，89.9%（97/108例患者）出院时未使用华法林；在以NSR出院的未接受胺碘酮治疗的患者中，92%（23/25）出院时未使用华法林（P = 0.74）。
SAVR后的POAF似乎很常见。虽然胺碘酮常用于POAF患者，但其使用似乎与外科医生决定对患者进行抗凝无关。外科医生对SAVR后POAF使用节律控制和抗栓治疗的偏好值得进一步探讨。
