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Vessel Plus 2022;6:[Accepted].10.20517/2574-1209.2022.11© The Author(s) 2022
Accepted Manuscript
Open AccessOriginal Article

Predictors and risk-adjusted outcomes of new-onset postoperative atrial fibrillation in repeat surgical and valve-in-valve transcatheter aortic valve replacement 

Correspondence Address: A. Laurie Shroyer, PhD, Professor and Vice Chair for Research, Department of Surgery, Stony Brook Renaissance School of Medicine, MART level 8, room 08-014, 100 Nicolls Road, Stony Brook, New York, NY 11794-8191, USA. E-mail: AnnieLaurie.Shroyer@stonybrookmedicine.edu

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© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing, adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made.

Abstract

Aim: New-onset postoperative atrial fibrillation/flutter (POAF/AFL) complications have not been well studied for repeat aortic valve replacements (r-AVR); this study identified risk factors predisposing to POAF/AFL and POAF/AFL’s effect upon risk-adjusted outcomes.

Methods: Using New York State’s Statewide Planning and Research Cooperative System records (2005–2018), multivariable forward selection models identified risks predictive of POAF/AFL. To identify POAF/AFL’s impact upon risk-adjusted mortality/morbidity (MM) and 30-day readmission (READMIT), forward selection logistic regression models applied Firth bias correction to address data sparsity.

Results: Of the 242 r-AVR patients, 147 underwent repeat surgical aortic valve replacements (r-SAVR) and 95 underwent valve-in-valve transcatheter aortic valve replacements (ViV-TAVR); 39.46% of r-SAVR and 43.16% of ViV-TAVR patients had POAF/AFL. R-SAVR patients with POAF/AFL were older (69.7 ± 11.1 vs. 56.7±13.2 years, P < 0.01) compared to R-SAVR patients without POAF/AFL. Multivariable models identified an enhanced POAF/AFL risk for elderly (OR: 1.05, 95%CI: 1.03–1.07, P < 0.01) and cerebral vascular disease (OR: 2.18, 95%CI: 1.05–4.55, P = 0.04) patients. Bivariately, POAF/AFL was associated with READMIT, but not MM. Correspondingly, multivariable models found POAF/AFL increased READMIT (OR: 3.12, 95%CI: 1.46–6.65, P < 0.01), but not MM. However, black race (OR: 4.97, 95%CI: 1.61–15.37, P < 0.01) and Elixhauser score (OR: 1.05, 95%CI: 1.02–1.08, P < 0.01) increased risk for MM.

Conclusion: More common in older and cerebrovascular disease patients, 41% of r-AVR patients with POAF/AFL had increased READMIT risk; thus, future investigations should focus on improving POAF/AF r-AVR patients’ post-discharge continuity of care.

Cite This Article

Dokko J, Novotny S, Kolba N, Agha S, Yaligar A, Tummala V, Parikh PB, Pryor AD, Tannous HJ, Shroyer AL, BIlfinger T. Predictors and risk-adjusted outcomes of new-onset postoperative atrial fibrillation in repeat surgical and valve-in-valve transcatheter aortic valve replacement. Vessel Plus 2022;6:[Accept]. http://dx.doi.org/10.20517/2574-1209.2022.11

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