Study Examines Onset of AFib After AVR

Today atrial fibrillation (AFib) is the most common complication to arise after cardiac surgery. For many physicians pericardial inflammation is believed to a strong contributor to the condition’s rate of occurrence, despite a scarcity of data comparing the frequency of postoperative AFib in procedure that can be performed with and without a pericardiotomy.

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  • A study published Jan. 29 in the Journal of the American College of Cardiology showed that AFib is a common complication of aortic valve replacement, "with a cumulative incidence of more than 40 percent in elderly patients with degenerative aortic stenosis who underwent either surgical aortic valve replacement (SAVR) or transcatheter aortic valve replacement (TAVR)."

    Since its introduction into the U.S. market, TAVR has become the preferred therapy among cardiologists with inoperable patients suffering from severe aortic stenosis and is regarded a safe alternative to surgical aortic valve replacement (SAVR) for those considered at high surgical risk. Because TAVR can be delivered three different ways – transfemoral (TF-TAVR), transapical (TA-TAVR), and transaortic (TAo-TAVR) – understanding the incidence of postoperative AFib for each method could provide clinicians with the best procedure option for their patients.

    The study, led by Tanyanan Tanawuttiwat, MD, cardiovascular division, department of medicine, University of Miami Miller School of Medicine, evaluated a total of 231 consecutive patients undergoing aortic valve replacement for degenerative aortic stenosis between March 2010 and September 2012 – excluding 108 who expired within 48 hours. Data on any documented episodes of new-onset AFib, along with all clinical, echocardiographic, procedural and 30-day follow-up data were collated.

    With AFib occurring in 52 patients, its incidence rate varied depending on the procedural method, taking place in 60 percent of patients undergoing SAVR, 53 percent after TA-TAVR, 33 percent after Tao-TAVR, and 14 percent after TF-TAVR.

    The authors conclude that AFib was associated with SAVR and least common with TF-TAVR. Further, the development of postoperative AFib was most closely associated with procedures that involved a pericardiotomy (SAVR and TA-TAVR).

    "In our increasingly cost-conscious world of medical care, minimizing risks of complication and safely reducing the length of a hospitalization are desirable goals," writes Phillip Cuculich, MD, Cardiovascular Division, Department of Medicine, Barnes-Jewish Hospital, in an editorial. "The results from the study by Tanawuttiwat and colleagues add to our overall understanding of the contribution of pericardiotomy to the incidence of postoperative AFib. Decisions about the relative merits of SAVR versus TAVR and between types of TAVR should include data from this study. Extended further, the unique comparisons of procedures with and without pericardiotomy may provide a way to study specific mechanisms related to the pericardium and help develop targeted, cost effective AFib prevention strategies."

    Keywords: Incidence, Risk, Cardiac Surgical Procedures, Postoperative Period

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