Abstract 12778: Occurrence of Atrial Fibrillation Following Surgical Aortic Bioprosthesis Implantation: Implications for Anticoagulation Therapy
Background: One of the main advantages of valvular bioprotheses (BP) is that they allow to avoid chronic anticoagulation therapy. However, atrial fibrillation (AF) is common in this population both before and after the surgical procedure and may interfere with the decision to anticoagulate or not. This aim of this prospective study was to assess the frequency of AF after aortic BP implantation.
Methods: From July 2008 to October 2009, we prospectively included all consecutive patients who underwent BAVR in our department and received postoperative oral antithrombotic treatment (aspirin or vitamin K antagonist ± aspirin). The choice of the treatment was at the discretion of the surgeon and the cardiologist. Non-inclusion criteria were mitral valve surgery and patient under 18 years of age. Patients were followed for 3 months. Complications were recorded during early (<7 days), intermediate (7-30 days) and late (30-90 days) follow-up (FU).
Results: Two-hundred and forty patients were included. Their mean age was 74 years (IQR [75-80]) and the mean logistic Euroscore was 5.4 (IQR [3.3 to 11]). Twenty-one patients (8%) died postoperatively after a median of 10 days ([IQR 8-14]). AF was present in 33 (13.7%) of patients before surgery and regressed in 8 post-operatively. Among the 207 patients free from AF before surgery, AF occurred in 62 (30%) at early FU, 20 (10%) during intermediate FU and 37 (18%) at late FU. Only 127 (61%) of patients remained free from AF at any time. Among the 165 patients in sinus rhythm after early FU, 18 subsequently developed AF at intermediate and late FU. Risk factors for AF were age (p=0.06) for early AF and smoking (p<0.001) and hypertension (p<0.01) for intermediate AF. Presence of AF at any time period was unrelated with mortality.
Conclusion: Only 61% of patients remain free from AF any time during short-term FU after surgical aortic valve replacement with a BP and the occurrence of AF in those who were initially in sinus rhythm is largely unpredictable. These data should be taken into account in the management of postoperative vitamin K antagonist and/or antiplatelet therapy.
- © 2011 by American Heart Association, Inc.