New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Indja, Ben; Woldendorp, Kei; Vallely, Michael P.; Grieve, Stuart M.

doi:10.1016/j.hlc.2020.03.012

Cited by 10 publications

(6 citation statements)

References 47 publications

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“…According to literature, the reason for the postoperative development of NOAF after the replacement of the aortic valve may be related to electrolyte disbalance, systemic inflammatory reaction and local pericardial and myocardial inflammation after the surgery [9]. Nevertheless, despite that NOAF after surgical procedures in most cases is transient, but it is related to higher rate of stroke and mortality [10].…”

Section: Discussionmentioning

confidence: 99%

Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

2024

Cardiol Res Cardiovasc Med

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Background: There are many studies comparing surgical (SAVR) and transcatheter (TAVR) aortic valve replacement, but in most cases patients with complex coronary artery disease (CAD) were excluded from the trials. Aim: To evaluate clinical outcomes and echocardiography parameters of TAVR and percutaneous coronary intervention (PCI) compared with SAVR and coronary arteries bypass grafting (CABG) procedures in patients with concomitant aortic stenosis (AS) and CAD. Methods: Retrospective study involved 200 patients with significant AS with CAD, requiring prosthetic valve implantation and interventional or surgical CAD treatment. Data collected were epidemiological data, comorbidities, and echocardiography parameters before the aortic valve replacement and within a month after the replacement, the type of prosthesis, and early complications of the procedure and mortality rate for four years. Results: A total of 200 patients who underwent TAVR + PCI (100 patients) or SAVR + CABG (100 patients) were included. After 30 days follow-up period, there was no significant difference between groups for all causes mortality (3% vs. 9%, p=0.134). A new onset atrial fibrillation (8% vs. 34 %, p<0.001), acute kidney injury (0% vs. 7%, p=0.014) and red blood cells transfusions (10% vs. 24%, p=0.008) were significantly lower in patients undergoing TAVR + PCI compared to SAVR + CABG. Postoperative peak aortic valve gradient was significantly higher in the SAVR group (25.77 ± 1.39 mmHg) compared to patients treated with TAVR (15.56 ± 0.66 mmHg, p=0.002). Mild or greater paravalvular leakage (PVL) was more frequent in the TAVR group (43%) than in the SAVR group (22%, p < 0.001). Mortality rate for four years was assessed -there was a tendency of higher mortality rates in TAVR + PCI group, but this difference was not statistically significant. Conclusions: Compared to SAVR + CABG surgery, TAVR + PCI procedure, had lower rates for acute kidney injury (AKI), new onset atrial fibrillation (NOAF) and red blood cells (RBC) transfusions following 30 days analysis. Postoperative valve performance data showed that the peak gradient was lower in TAVR + PCI group, while the rates of significant aortic regurgitation were higher in this group. Long-term mortality rates tend to be higher in TAVR + PCI group, but this difference was not statistically significant.

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Section: Discussionmentioning

confidence: 99%

Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

2024

Cardiol Res Cardiovasc Med

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“…For first-time AVR procedures, POAF/AFL has been associated with worse mortality, higher rates of stroke, increased length of stay, and readmission [10,16,18,30,31] . Historically, the impact of POAF/AFL in r-AVR patients has not been similarly investigated.…”

Section: Discussionmentioning

confidence: 99%

“…As aortic valves inherently have limited durability, bioprosthetic valves often experience structural deterioration within 10-12 years, and thus require repeat procedures [7] . For repeat AVR (r-AVR) patients, the POAF/AFL incidence was reportedly increased for more invasive procedures (35.5%-60% of SAVR and 10.4%-50.4% of TAVR patients); POAF/AFL has been associated with greater mortality, stroke, and hospital resource utilization [6,[8][9][10][11][12][13][14][15][16][17][18] . For example, one single-center study has shown 63.6% of 22 r-SAVR and 18.2% of 22 valve-in-valve transcatheter aortic valve replacements (ViV-TAVR) patients to have POAF/AFL [19] .…”

Section: Introductionmentioning

confidence: 99%

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

Dokko¹

2022

Vessel Plus

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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.

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“…For instance, atrial fibrillation is present in approximately 30-40% of patients undergoing TAVI [31,33,34,[45][46][47][48][49][50], and this is particularly relevant because patients undergoing TAVI often have various comorbidities and higher bleeding risk. Although patients undergoing TAVI have a lower incidence of new-onset atrial fibrillation compared to those undergoing SAVR with severe aortic stenosis [51,52], it remains an important element to consider in the management of antithrombotic therapy, especially because it is correlated with an elevated incidence of stroke and mortality during the initial year [24,43,50,[53][54][55].…”

Section: Patients With a Clinical Indication For Oacmentioning

confidence: 99%

Antithrombotic Therapy in Patients Undergoing Transcatheter Aortic Valve Implantation

Pallante,

Costa,

Garcia Ruiz

et al. 2024

JCM

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Transcatheter aortic valve implantation (TAVI) now represents the mainstay of treatment for severe aortic stenosis. Owing to its exceptional procedural efficacy and safety, TAVI has been extended to include patients at lower surgical risk, thus now encompassing a diverse patient population receiving this treatment. Yet, long-term outcomes also depend on optimal medical therapy for secondary vascular prevention, with antithrombotic therapy serving as the cornerstone. Leveraging data from multiple randomized controlled trials, the current guidelines generally recommend single antithrombotic therapy, with either single antiplatelet therapy (SAPT) or oral anticoagulation (OAC) alone in those patients without or with atrial fibrillation, respectively. Yet, individualization of this pattern, as well as specific case uses, may be needed based on individual patient characteristics and concurrent procedures. This review aims to discuss the evidence supporting antithrombotic treatments in patients treated with TAVI, indications for a standardized treatment, as well as specific considerations for an individualized approach to treatment.

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New Onset Atrial Fibrillation Following Transcatheter and Surgical Aortic Valve Replacement: A Systematic Review and Meta-Analysis

Cited by 10 publications

References 47 publications

Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

Outcomes of Complete Transcatheter versus Complete Surgical Treatment in Patients with Severe Aortic Valve Stenosis and Concomitant Coronary Artery Disease

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

Antithrombotic Therapy in Patients Undergoing Transcatheter Aortic Valve Implantation

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