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Eur J Cardiothorac Surg 2005;28:206-210
© 2005 Elsevier Science NL

Original articles

Conversion to sinus rhythm does not improve long-term survival after valve surgery: insights from a 20-year follow-up study

Department of Surgery, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Que., Canada H1T 1C8

Received 25 October 2004; received in revised form 10 March 2005; accepted 14 March 2005.

^* Corresponding author. Address: Department of Cardiac Surgery, Montreal Heart Institute, 5000 Bélanger Street East, Montreal, Que., Canada H1T 1C8. Tel.: +1 514 376 3330; fax: +1 514 376 4766/+1 514 593 2157. (Email: denis.bouchard{at}icm-mhi.org).

Abstract

Objective: Atrial fibrillation (AF) is frequently associated with valvular heart disease and a common complication of valve surgery. Its contribution to long-term mortality and morbidity remains debated. Our objective was to determine the impact of AF on long-term mortality and embolic complications after valvular surgery and the benefit of conversion to sinus rhythm. This may provide insight to the clinical advantages of surgical anti-AF procedures. Methods: Data concerning rhythm status, mortality and embolic complications were prospectively collected for 5466 patients with valve surgery. Patients had surgery between 1979 and 2003. Follow-up was complete and all patients had a yearly EKG. Results: Patients with preoperative AF had poorer long-term survival than patients without preoperative AF (20-year survival 23.7 and 33.4%, respectively, P<0.0001). However, preoperative AF was not an independent risk factor of long-term mortality (HR=1.04, P=0.6). In patients with preoperative sinus rhythm, postoperative development of AF had an impact on long-term mortality (HR=1.46, P=0.0012). In patients with preoperative AF, postoperative rhythm did not influence mortality when adjusted for other variables (AF vs. sinus rhythm, HR=1.07, P=0.5709). Mitral valve surgery (HR=1.55, P=0.0270) but not preoperative or postoperative AF had a significant impact on the advent of embolic complications. Conclusions: The conversion to sinus rhythm did not improve long-term survival or reduce the incidence of embolic complications after valve surgery. Patients with preoperative AF had poorer survival than patients without preoperative AF. AF may be a marker of advanced disease in these patients.

Key Words: Valvular surgery • Atrial fibrillation • Valvular heart disease • Mortality • Embolic events

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