De novo atrial fibrillation following aortic valve replacement surgery is associated with decreased creatinine clearance and increased C-reactive protein levels
Mariana Fragão-Marques1, Francisca Saraiva1, João Oliveira1,, , André P. Lourenço1, Adelino Leite-Moreira1,2, Inês Falcão-Pires1
1 Departamento de Cirurgia e Fisiologia da Faculdade de Medicina da Universidade do Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal
2 Departamento de Cirurgia Cardiotorácica do Centro Hospitalar de São João, Porto, Alameda Professor Hernâni Monteiro, Porto, Portugal

Aim: We aim to assess the prevalence of de novo postoperative atrial fibrillation (POAF) in patients submitted to aortic valve replacement surgery (AVRS) and evaluate clinical and echocardiographic variables as predictors of POAF occurrence in this population.

Introduction: POAF is the most common complication following cardiac surgery, with peak incidence in the second day after the surgical procedure. Studies have demonstrated an increase in the incidence of stroke, hospital stay, health- associated costs and mortality in the group of patients experiencing POAF.

Methods: We conducted a cross-sectional study, that included all the patients submitted to AVRS during 2014 in a tertiary hospital, diagnosed with severe aortic valve stenosis without endocarditis, known history of atrial fibrillation, more than one major procedure, or other significant valve disease. Data were collected retrospectively and the statistical tests were performed according to the variable classification.

Results: The incidence of POAF in the 173 included patients was 45%, with the median time of occurrence being 2.4±1.5 days. A univariate analysis showed that the group of patients who developed POAF was older (p=0.028), had longer median in-hospital stay (p=0.008), had a significantly higher C-reactive protein (CRP) peak blood level (p=0.025) and a significantly lower minimum creatinine clearance (p=0.026) in the post-operative period when compared with those who did not develop POAF. A multivariate analysis confirmed age to be an independent predictor of POAF. (OR: 1.04, CI 95%: 1.00–1.09).

Conclusion: Our study suggests age, peak post-operative blood level of CRP and creatinine clearance as predictors of POAF occurrence and supports the hypothesis that POAF may be the result of inflammation, being one of the few studies that focuses on a population with isolated aortic stenosis. Our findings on increased hospital stay reinforce the idea of risk stratification and the use preventive measures in the higher risk groups.

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