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Tsuda PS, McNeely CA, Markwell SJ, et al. Mitral Valve Surgery in The Elderly: Should We Treat Atrial Fibrillation Too?. J Heart Valve Dis. 2015;24(6):736-743
Tsuda, P. S., McNeely, C. A., Markwell, S. J., Hazelrigg, S. R., & Vassileva, C. M. (2015). Mitral Valve Surgery in The Elderly: Should We Treat Atrial Fibrillation Too?. The Journal of heart valve disease, 24(6), 736-743.
Tsuda, Paige S, et al. "Mitral Valve Surgery in The Elderly: Should We Treat Atrial Fibrillation Too?." The Journal of heart valve disease vol. 24,6 (2015): 736-743.
Tsuda PS, McNeely CA, Markwell SJ, Hazelrigg SR, Vassileva CM. Mitral Valve Surgery in The Elderly: Should We Treat Atrial Fibrillation Too?. J Heart Valve Dis. 2015 Nov;24(6):736-743. PMID: 27997780.
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J Heart Valve Dis. 2015 Nov;24(6):736-743.

Mitral Valve Surgery in The Elderly: Should We Treat Atrial Fibrillation Too?.

The Journal of heart valve disease

Paige S Tsuda, Christian A McNeely, Stephen J Markwell, Stephen R Hazelrigg, Christina M Vassileva

Affiliations

  1. Division of Cardiothoracic Surgery, Southern Illinois University School of Medicine, Springfield, Illinois, USA.

PMID: 27997780

Abstract

BACKGROUND: The study aim was to examine whether concomitant atrial fibrillation (AF) surgery at the time of mitral valve surgery in the elderly results in increased operative mortality (OM).

METHODS: Medicare beneficiaries aged ≥65 years undergoing primary mitral valve repair or replacement between 2004 and 2006 were included. The cohort was divided into three groups: Group 1, AF- (n = 2,705); group 2, AF+AF surgery- (n = 2,119), and group 3, AF+AF surgery+ (n = 1,832). The primary outcomes were OM and long-term survival. A secondary outcome was the association between hospital annual mitral procedure volume and OM.

RESULTS: The unadjusted OM was 6.4% for group 1 (AF-), 10.3% for group 2 (AF+AF surgery-), and 7.1% for group 3 (AF+AF surgery+) (p = 0.0001). Adjusted OM for AF+AF surgery+ patients was not significantly different from that of AF- patients (OR 1.16, 95% CI 0.90-1.48), or from AF+AF surgery patients (OR 0.83, 95% CI 0.66-1.06). When comparisons were adjusted for differences in baseline characteristics, AF+AF surgery- patients were more likely to experience long-term mortality than AF- patients (HR 1.30, 95% CI 1.17-1.45), as well as AF+AF surgery+ patients (HR 1.17, 95% CI 1.05-1.31). An annual average mitral procedure volume ≤40 was independently predictive of OM (OR 1.42, 95% CI 1.13-1.78). The effect of institutional volume on mortality was strongest in those who received AF surgery (AF+AF surgery+) (HR 1.75, 95% CI 1.15-2.65), compared to those who did not undergo surgery (AF+AF surgery-) (OR 1.20, 95% CI 0.86-1.67).

CONCLUSIONS: Elderly patients undergoing mitral valve surgery do not appear to have an increased mortality when clinical judgment favored the performance of concomitant AF surgery.

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