Prognostic impact of preoperative atrial fibrillation in patients undergoing heart surgery in cardiogenic shock.

Dec 11, 2023

Experts: Mariusz Kowalewski,Giuseppe M Raffa,Michał Pasierski,Michalina Kołodziejczak,Radosław Litwinowicz,Wojciech Wańha,Wojciech Wojakowski,Jan Rogowski,Marek Jasiński,Kazimierz Widenka,Tomasz Hirnle,Marek Deja,Krzysztof Bartus,Roberto Lorusso,Zdzisław Tobota,Bohdan Maruszewski,Piotr Suwalski,

Surgical intervention in the setting of cardiogenic shock (CS) is burdened with high mortality. Due to acute condition, detailed diagnoses and risk assessment is often precluded. Atrial fibrillation (AF) is a risk factor for perioperative complications and worse survival but little is known about AF patients operated in CS. Current analysis aimed to determine prognostic impact of preoperative AF in patients undergoing heart surgery in CS. We analyzed data from the Polish National Registry of Cardiac Surgery (KROK) Procedures. Between 2012 and 2021, 332,109 patients underwent cardiac surgery in 37 centers; 4852 (1.5%) patients presented with CS. Of those 624 (13%) patients had AF history. Cox proportional hazards models were used for computations. Propensity score (nearest neighbor) matching for the comparison of patients with and without AF was performed. Median follow-up was 4.6 years (max.10.0), mean age was 62 (± 15) years and 68% patients were men. Thirty-day mortality was 36% (1728 patients). The origin of CS included acute myocardial infarction (1751 patients, 36%), acute aortic dissection (1075 patients, 22%) and valvular dysfunction (610 patients, 13%). In an unadjusted analysis, patients with underlying AF had almost 20% higher mortality risk (HR 1.19, 95% CIs 1.06-1.34; P = 0.004). Propensity score matching returned 597 pairs with similar baseline characteristics; AF remained a significant prognostic factor for worse survival (HR 1.19, 95% CI 1.00-1.40; P = 0.045). Among patients with CS referred for cardiac surgery, history of AF was a significant risk factor for mortality. Role of concomitant AF ablation and/or left atrial appendage occlusion or more aggressive perioperative circulatory support should be addressed in the future.
© 2023. The Author(s).

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ABOUT THE EXPERTS

Mariusz Kowalewski,Giuseppe M Raffa,Michał Pasierski,Michalina Kołodziejczak,Radosław Litwinowicz,Wojciech Wańha,Wojciech Wojakowski,Jan Rogowski,Marek Jasiński,Kazimierz Widenka,Tomasz Hirnle,Marek Deja,Krzysztof Bartus,Roberto Lorusso,Zdzisław Tobota,Bohdan Maruszewski,Piotr Suwalski,

Mariusz Kowalewski

Clinical Department of Cardiac Surgery and Transplantology, Centre of Postgraduate Medical Education, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str, 02-507, Warsaw, PL, Poland. kowalewskimariusz@gazeta.pl.

Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands. kowalewskimariusz@gazeta.pl.

Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy. kowalewskimariusz@gazeta.pl.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland. kowalewskimariusz@gazeta.pl.

Giuseppe M Raffa

Department for the Treatment and Study of Cardiothoracic Diseases and Cardiothoracic Transplantation, IRCCS-ISMETT, Palermo, Italy.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.

Michał Pasierski

Clinical Department of Cardiac Surgery and Transplantology, Centre of Postgraduate Medical Education, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str, 02-507, Warsaw, PL, Poland.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.

Michalina Kołodziejczak

Department of Anaesthesiology and Intensive Care, Ludwik Rydygier Collegium Medicum, Nicolaus Copernicus University, Antoni Jurasz University Hospital No. 1, Bydgoszcz, Poland.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.

Radosław Litwinowicz

Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.

Wojciech Wańha

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.

Wojciech Wojakowski

Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.

Jan Rogowski

Department of Cardiac and Vascular Surgery, Medical University of Gdansk, Gdansk, Poland.

Marek Jasiński

Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland.

Kazimierz Widenka

Clinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzeszów, Rzeszów, Poland.

Tomasz Hirnle

Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland.

Marek Deja

Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland.

Krzysztof Bartus

Department of Cardiac Surgery, Regional Specialist Hospital, Grudziądz, Poland.

Roberto Lorusso

Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, The Netherlands.

Zdzisław Tobota

Department of Pediatric Cardiothoracic Surgery, The Children’s Memorial Health Institute, Warsaw, Poland.

Bohdan Maruszewski

Department of Pediatric Cardiothoracic Surgery, The Children’s Memorial Health Institute, Warsaw, Poland.

Piotr Suwalski

Clinical Department of Cardiac Surgery and Transplantology, Centre of Postgraduate Medical Education, National Medical Institute of the Ministry of Interior and Administration, Wołoska 137 Str, 02-507, Warsaw, PL, Poland.

Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.