Long-term Impact of Postoperative Atrial Fibrillation after Endoscopic Mitral Valve Surgery

Background: Postoperative atrial fibrillation (postAF) occurs frequently after cardiac surgery and is associated with several cardiovascular adverse events potentially resulting in an increased long-term morbidity and mortality. Nevertheless, the impact of postAF after endoscopic mitral valve surgery (endoMVS) remains to be investigated.

Methods: Between 2012 and 2022, 1,031 consecutive patients underwent fully endoMVS with 3D-camera visualization at our center. Patients were categorized according to the prevalence of postoperative AF (group 1: no postAF; n = 632 versus group 2: postAF; n = 399). Data were retrospectively analyzed.

Results: PostAF during in-hospital stay after endoMVS occurred in 38.7% of patients. Patients without postAF were significantly younger (group 1: 58 versus group 2: 64 years; p < 0.001) and presented with a lower prevalence of hypertension (p < 0.001), s/p stroke (p = 0.034), coronary artery disease (p < 0.001), and preoperative AF (13.8 versus 61.9%; p < 0.001). Accordingly, median STS PROM Score was significantly lower in group 1 (0.3 [0.2–0.6] versus 0.5 [0.3–0.9] versus 0.6 [0.4–1.2]; p < 0.001). Group 1 patients were less symptomatic (NYHA III/IV: 33.4 versus 42.9%; p = 0.025), showed lower levels of NT-proBNP, and better left and right ventricular function (all p < 0.001). Secondary MR (10.3 versus 18.2%; p < 0.001) and concomitant TR > 2+ (13.1 versus 26.8%; p < 0.001) were less frequent in group 1. MV repair was achieved in 94.3 versus 90.2% (p = 0.020). Median procedural (p = 0.43) and cross-clamp (p = 0.48) times were comparable between groups. Of note, postoperative ventilation time, and length of stay on ICU and in-hospital stay (all p < 0.001) were significantly lower in group 1. Rates of perioperative low-cardiac output syndrome (p < 0.001), permanent pacemaker implantation (p = 0.034), and re-thoracotomy due to bleeding (p = 0.001) were lower in group 1. 58.9% of group 2 patients were discharged showing sinus rhythm. At 30 days, overall mortality was 0.3 versus 0.8% (p = 0.60). After 5 years, freedom from death was significantly impaired in group 2 (p = 0.023).

Conclusion: PostAF occurred in 38.7% of patients undergoing endoMVS. Although the prevalence of comorbidities, surgical risk, and perioperative adverse events were increased in patients with postAF, 30-day survival was not impaired. Nevertheless, 5-year survival was significantly worse in patients with postAF. Therefore, perioperative rhythm management and anticoagulation after endoMVS are of paramount importance.

 

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No conflict of interest has been declared by the author(s).

Publication History

Article published online:
11 February 2025