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J Chest Surg

Published online July 13, 2022

Copyright © Journal of Chest Surgery.

Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery

Hyo-Hyun Kim, M.D. , Ji-Hong Kim, M.D. , Sak Lee, M.D., Ph.D. , Hyun-Chel Joo, M.D. , Young-Nam Youn, M.D., Ph.D. , Kyung-Jong Yoo, M.D., Ph.D. , Seung Hyun Lee, M.D., Ph.D.

Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea

Correspondence to:Seung Hyun Lee
Tel 82-2-2228-8489
Fax 82-2-313-2992
E-mail henry75@yuhs.ac
ORCID
https://orcid.org/0000-0002-0311-6565

Received: December 9, 2021; Revised: April 8, 2022; Accepted: April 27, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database.
Methods: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision.
Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263–2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266–0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib.
Conclusion: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

Keywords: Atrial fibrillation, Maze procedure, Database

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J Chest Surg

Published online July 13, 2022

Copyright © Journal of Chest Surgery.

Long-Term Outcomes of Preoperative Atrial Fibrillation in Cardiac Surgery

Hyo-Hyun Kim, M.D. , Ji-Hong Kim, M.D. , Sak Lee, M.D., Ph.D. , Hyun-Chel Joo, M.D. , Young-Nam Youn, M.D., Ph.D. , Kyung-Jong Yoo, M.D., Ph.D. , Seung Hyun Lee, M.D., Ph.D.

Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Yonsei University Health System, Seoul, Korea

Correspondence to:Seung Hyun Lee
Tel 82-2-2228-8489
Fax 82-2-313-2992
E-mail henry75@yuhs.ac
ORCID
https://orcid.org/0000-0002-0311-6565

Received: December 9, 2021; Revised: April 8, 2022; Accepted: April 27, 2022

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Background: Atrial fibrillation (Afib) is a marker of increased cardiovascular morbidity and mortality. Owing to the increased prevalence of Afib in patients undergoing cardiac surgery, assessing the effect of Afib on postsurgical outcomes is important. We aimed to analyze the effect of preoperative Afib on clinical outcomes in patients undergoing cardiac surgery using a large surgical database.
Methods: This retrospective cohort study was based on the national health claims database established by the National Health Insurance Service of the Republic of Korea from 2009 to 2015. Diagnosis and procedure codes were used to identify diseases according to the International Statistical Classification of Diseases, 10th revision.
Results: We included 1,037 patients (0.1%) who had undergone cardiac surgery from a randomized 1,000,000-patient cohort, and 15 patients (1.5%) treated with isolated surgical Afib ablation were excluded. Of these 1,022 patients, 412 (39.7%), 303 (29.2%), and 92 (9.0%) underwent coronary artery bypass, heart valve surgery, and Cox-maze surgery, respectively. Preoperative Afib was associated with higher patient mortality (p=0.028), regardless of the surgical procedure. Patients with preoperative Afib (n=190, 18.6%) experienced a higher cumulative risk of overall mortality (hazard ratio [HR], 1.435; 95% confidence interval [CI], 1.263–2.107; p=0.034). Subgroup analysis revealed a reduced risk of overall mortality with Cox-maze surgery in Afib patients (HR, 0.500; 95% CI, 0.266–0.938; p=0.031). Postoperative cerebral ischemia or hemorrhage events were not related to Afib.
Conclusion: Preoperative Afib was independently associated with worse long-term postoperative outcomes after cardiac surgery. Concomitant Cox-maze surgery may improve the survival rate.

Keywords: Atrial fibrillation, Maze procedure, Database

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