Long-Term Effects of Postoperative Atrial Fibrillation following Mitral Valve Surgery

SIMPLE SUMMARY: The incidence of postoperative atrial fibrillation (PoAF) after mitral valve surgery has not been thoroughly evaluated. This study evaluated postoperative atrial fibrillation incidence and its short- and long-term effects in patients who underwent mitral valve surgery. The overall incidence of PoAF was 16.8%. PoAF was associated with higher operative mortality, stroke, and dialysis. ICU and hospital stays were significantly longer in patients with PoAF. PoAF was significantly associated with increased mortality risk, heart failure rehospitalization, and stroke. The study revealed that atrial fibrillation after mitral valve surgery is common. PoAF was associated with an increased risk of short- and long-term adverse events. Future studies are needed to evaluate strategies that can be implemented to improve the outcomes of these patients. These strategies include the use of preventive antiarrhythmic therapy and close follow-up of those patients. ABSTRACT: Background: New-onset postoperative atrial fibrillation (PoAF) is one of the most frequent yet serious complications following cardiac surgery. Long-term consequences have not been thoroughly investigated, and studies have included different cardiac operations. The objectives were to report the incidence and short- and long-term outcomes in patients with PoAF after mitral valve surgery. Methods: This is a retrospective cohort study of 1401 patients who underwent mitral valve surgery from 2009 to 2020. Patients were grouped according to the occurrence of PoAF (n = 236) and the nonoccurrence of PoAF (n = 1165). Long-term outcomes included mortality, heart failure rehospitalization, stroke, and mitral valve reinterventions. Results: The overall incidence of PoAF was 16.8%. PoAF was associated with higher rates of operative mortality (8.9% vs. 3.3%, p < 0.001), stroke (6.9% vs. 1.5%, p < 0.001), and dialysis (13.6% vs. 3.5%, p < 0.001). ICU and hospital stays were significantly longer in patients with PoAF (p < 0.001 for both). PoAF was significantly associated with an increased risk of mortality [HR: 1.613 (95% CI: 1.048–2.483); p = 0.03], heart failure rehospitalization [HR: 2.156 (95% CI: 1.276–3.642); p = 0.004], and stroke [HR: 2.722 (95% CI: 1.321–5.607); p = 0.007]. However, PoAF was not associated with increased mitral valve reinterventions [HR: 0.938 (95% CI: 0.422–2.087); p = 0.875]. Conclusions: Atrial fibrillation after mitral valve surgery is a common complication, with an increased risk of operative mortality. PoAF was associated with lower long-term survival, increased heart failure rehospitalization, and stroke risk. Future studies are needed to evaluate strategies that can be implemented to improve the outcomes of these patients.