JTCS Email Content Delivery
HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
QUICK SEARCH:   [advanced]


     

This Article
Right arrow Full Text
Right arrow Full Text (PDF)
Right arrow Alert me when this article is cited
Right arrow Alert me if a correction is posted
Right arrow Citation Map
Services
Right arrow Email this article to a friend
Right arrow Similar articles in this journal
Right arrow Alert me to new issues of the journal
Right arrow Add to Personal Folders
Right arrow Download to citation manager
Right arrow Author home page(s):
Joao Melo
Eva Berglin
Michael Knaut
Ottavio Alfieri
Stefano Benussi
Mathew Williams
Fernando Hornero
Paul Ridley
Enrique Fulquet-Carreras
Right arrow Permission Requests
Citing Articles
Right arrow Citing Articles via Google Scholar
Google Scholar
Right arrow Articles by Melo, J.
Right arrow Articles by Ferreira, A.
Right arrow Search for Related Content
PubMed
Right arrow Articles by Melo, J.
Right arrow Articles by Ferreira, A.
Related Collections
Right arrow Electrophysiology - arrhythmias
Right arrow Valve disease
Right arrowRelated Article

J Thorac Cardiovasc Surg 2008;135:863-869
© 2008 The American Association for Thoracic Surgery

Surgery for Acquired Cardiovascular Disease

Surgery for atrial fibrillation in patients with mitral valve disease: Results at five years from the International Registry of Atrial Fibrillation Surgery

Joao Melo, MD, PhDa,*, Teresa Santiago, MSca, Carlos Aguiar, MDa, Eva Berglin, MD, PhDb, Michael Knaut, MDc, Ottavio Alfieri, MD, PhDd, Stefano Benussi, MD, PhDd, Haw Sie, MDe, Mathew Williams, MDf, Fernando Hornero, MD, PhDg, Giuseppi Marinelli, MDh, Paul Ridley, MDi, Enrique Fulquet-Carreras, MDj, António Ferreira, MDa

a Hospital Sta Cruz, Carnaxide, Portugal
b Sahlgrenska University Hospital, Goteborg, Sweden
c Dresden University Hospital, Dresden, Germany
d San Raffaele Hospital, Milano, Italy
e Isala Klinieken, Zwolle, The Netherlands
f Columbia University Medical Center, New York, NY
g Hospital General Universitario de Valencia, Valencia, Spain
h Policlinico S. Orsola, Bologna, Italy
i North Staffordshire Royal Infirmary, Staffordshire, United Kingdom
j Hospital Universitario de Valladolid, Vallodolid, Spain

Received for publication April 28, 2006; revisions received June 25, 2007; accepted for publication August 30, 2007.

* Address for reprints: Joao Melo, MD, PhD, Hospital de Santa Cruz, Av. Prf. Reynaldo dos Santos, 2799-523 Carnaxide, Portugal. (Email: jmelo{at}hsc.min-saude.pt).

Objectives: We sought to assess the clinical and survival benefit of atrial fibrillation surgery in patients submitted to mitral valve surgery after stabilization of postoperative rhythm at 1 year.

Methods: One thousand seven hundred twenty-three patients were enrolled. Patients with follow-up of longer than 1 year (n = 972) were divided into 3 groups according to surface electrocardiographic rhythm during follow-up visits: stable sinus rhythm, stable atrial fibrillation, and intermittent rhythms. Adverse cardiac event incidence and predictors of long-term outcome were compared among the 3 groups.

Results: In-hospital mortality was 2.6%. Risk factors for mortality were the cut-and-sew technique (odds ratio, 8.92; 95% confidence interval, 1.71–46.50; P = .009) and isolated left atrial procedure (odds ratio, 0.16; 95% confidence interval, 0.04–0.56; P = .004). At 1 year, 63.4% patients were in stable sinus rhythm. Stable sinus rhythm was found to be associated with early and late survival (P = .01, log-rank analysis). Multivariate binary logistic regression analysis found that left atrial dimension (odds ratio, 0.97; 95% confidence interval, 0.96–0.99; P = .005) and concomitant coronary revascularization (odds ratio, 0.48; 95% confidence interval, 0.25–0.92; P = .027) were independent predictors of stable sinus rhythm at 1 year after surgical intervention. At 48 months' follow-up, predictors for stable sinus rhythm were biatrial surgical approach and absence of preoperative permanent atrial fibrillation (odds ratio, 3.56; 95% confidence interval, 1.62–7.83; P < .002). Left atrial size (each millimeter) has a borderline statistical significance (odds ratio, 0.97; 95% confidence interval, 0.93–1.00; P = .065). Thromboembolic events were found to be associated with absence of stable sinus rhythm (P = .010, log-rank analysis).

Conclusions: The achievement of stable sinus rhythm is a predictor of better survival and lower incidence of thromboembolic events. Predictors of stable sinus rhythm were smaller dimensions of the left atrium, biatrial approach, absence of preoperative permanent atrial fibrillation, and absence of concomitant coronary artery bypass grafting.

Abbreviations and Acronyms CI = confidence interval; OR = odds ratio; RAFS = International Registry for Atrial Fibrillation Surgery; sAF = stable atrial fibrillation; sSR = stable sinus rhythm


Related Article

The surgical treatment for atrial fibrillation: A call for standardization
Niv Ad
J. Thorac. Cardiovasc. Surg. 2008 135: 727-728. [Extract] [Full Text] [PDF]





HOME HELP FEEDBACK SUBSCRIPTIONS ARCHIVE SEARCH TABLE OF CONTENTS
ANN THORAC SURG ASIAN CARDIOVASC THORAC ANN EUR J CARDIOTHORAC SURG
J THORAC CARDIOVASC SURG ICVTS ALL CTSNet JOURNALS
Copyright © 2008 by The American Association for Thoracic Surgery.