主动脉瓣置换术后新发房颤的术前预测因素

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Preoperative predictors of new-onset prolonged atrial fifibrillation after surgical aortic valve replacement

背景与目的

接受主动脉瓣置换术（SAVR）的患者术后发生持续性心房颤动（AF）风险极大。左心耳切除（LAAA）和肺静脉隔离（PVI）等预防性干预措施增加了手术成本和风险，并不能常规应用。为了指导术后AF治疗，本研究旨在探讨主动脉瓣置换术后新发心房颤动的术前预测因素。

方  法

对2011年至2017年接受SAVR的患者进行回顾性分析。如果患者术前有房颤病史，或接受了LAAA或PVI，则被排除在外。对术后房颤患者与非房颤患者的基线特征进行比较，采用多变量逻辑回归分析确定主动脉瓣置换术后新发房颤的预测因素。

结 果  

本研究共纳入720名患者中，其中170名（25%）患者出现长期房颤（超过30天）。与未出现房颤的患者相比，出现长期房颤的患者年龄更大（70.1岁vs 62.4岁，P<0.001），高血压发病率更高（78% vs 61%，P<0.001），吸烟的可能性更小（16% vs 31%，P<0.01）。在多变量回归分析中，高龄（OR=1.05；P<0.01）和左房增大（OR=1.66；P=0.04）是房颤时间延长的预测因素，在这一高危人群中，术后房颤时间延长的发生率为40%。

结 论

年龄越大伴左房增大，SAVR术后发生长期房颤的风险越高。

原始文献来源及摘要

Axtell AL,  Moonsamy P,  Melnitchouk S, etal; Preoperative predictors of new-onset prolonged atrial fifibrillation after surgical aortic valvereplacement；J. Thorac. Cardiovasc. Surg. 2019 May 17;PMID：31204133

OBJECTIVE:Patients undergoing surgical aortic valve replacement (SAVR) are at risk of developing prolonged atrial fibrillation (AF) after surgery. Prophylactic interventions such as left atrial appendage amputation (LAAA) and pulmonary vein isolation (PVI) impose cost and operative risk, discouraging routine use. To guide such interventions, we investigated preoperative predictors of AF.

METHODS:A retrospective analysis was performed on patients undergoing SAVR between 2011 and 2017. Patients were excluded if they had a preoperative history of AF or underwent a LAAA or PVI. Baseline characteristics were compared between those who did and did not develop prolonged postoperative AF. Predictors of prolonged AF were identified using multivariable logistic regression.

RESULTS:Of 720 patients identified, 170 (25%) developed prolonged (beyond 30 days) AF. Compared with patients who did not develop AF, those who developed prolonged AF were older (70.1 vs 62.4 years, P < .001), had a greater incidence of hypertension (78% vs 61%, P < .001), and were less likely to smoke (16% vs 31%, P < .01). On multivariable regression, older age (odds ratio, 1.05; P < .01) and left atrial enlargement (odds ratio, 1.66; P = .04) were predictors of prolonged AF. In this high-risk cohort, the incidence of prolonged postoperative AF was 40%.

CONCLUSIONS:Older age and left atrial enlargement identify a stratum of patients at high risk of developing prolonged postoperative AF after SAVR. Multicenter, prospective studies should investigate the value of prophylactic interventions such as LAAA, Cox maze, or PVI in these individuals to obviate the consideration of late anticoagulation.

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