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Thorac Cardiovasc Surg 2023; 71(04): 297-306
DOI: 10.1055/s-0041-1740985
Original Cardiovascular

Atrial Fibrillation after Rheumatic Heart Valve Surgery: Incidence, Predictors, and Outcomes

Khalid Shaker Ibrahim 
1   General Surgery Department, Jordan University of Science and Technology, Irbid, Jordan
,
Khaled Kheirallah
2   Department of Public Health, Jordan University of Science and Technology, Irbid, Jordan
,
Fadia Mayyas
3   Department of Clinical Pharmacy, Jordan University of Science and Technology, Irbid, Jordan
,
Nizar Waqfi
1   General Surgery Department, Jordan University of Science and Technology, Irbid, Jordan
,
Nabil Al-Zoubi
1   General Surgery Department, Jordan University of Science and Technology, Irbid, Jordan
,
David Van Wagner
4   Cleveland Clinic Lerner Research Institute, Cleveland, Ohio, United States
› Author Affiliations Funding None.
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Abstract

Background Atrial fibrillation after cardiac surgery (AFACS) impacts 10 to 65% of patients. AFACS is associated with stroke and other systemic embolic manifestations.

Methods Patients at our hospital who underwent rheumatic valve surgery procedures including aortic valve replacement (AVR), mitral valve replacement (MVR), AVR with coronary artery bypass grafting (CABG), MVR with CABG, or AVR and MVR with/without CABG were included in this study in the period from 2002 to 2017.

Results In total, 346 patients were included in the current analysis, with a mean age of 51.6 ± 16.1 years, and 51% were males. AFACS was documented in 102 patients (29.9%) . Univariate predictors of AFACS included age, gender, body mass index (BMI), operation type, left ventricular ejection fraction (EF), left atrial (LA) diameter, previous history of AF, use of aldosterone antagonists more than a month before surgery, use of diuretics more than a month before surgery, length of ICU stay, total length of stay, cross-clamp time more than 90 minutes, pump time more than 120 minutes, postoperative acute kidney injury, left ventricular dimensions.

By multivariate analysis, only age (p = 0.028, AOR = 10.6), male gender (p = 0.021, AOR = 3.4), type of surgery (p = 0.034, AOR = 7.12), history of AF (p = 0.018, AOR =  2.32), BMI (p < 0.001, AOR = 3.91), EF before surgery (p ≤ 0.001, AOR = 3.91), and LA diameter (p = 0.0051, AOR = 18.23) were independent predictors of AFACS.

Conclusion This study identifies risk factors associated with the development of atrial fibrillation after rheumatic valve heart surgery. Older patients, male gender, type of surgery, preoperative AF, BMI, EF before surgery, and LA diameter are independent predictors of AF after cardiac valve surgery.

Keywords

Atrial fibrillation - rheumatic heart disease - predictors - valve replacement - cardiac surgery

Limitations of the Study

This study is limited by its retrospective nature. Data are collected from patients' electronic and paper files. There are missing data; however, it did not reach 20% in most items. Future prospective studies are needed to overcome these limitations.


Authors' Contributions

1. Substantial contributions to conception and design, data acquisition, or data analysis and interpretation: All Authors.


2. Drafting the article or critically revising it for important intellectual content: All Authors


2. Final approval of the version to be published: All Authors


Supplementary Material



Publication History

Received: 10 August 2021

Accepted: 17 November 2021

Article published online:
02 February 2022

© 2022. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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