Abstract
Objective: This systematic review and meta-analysis was performed to evaluate the impact of preoperative atrial fibrillation (preAF) on early and late outcomes after mitral valve surgery (MVS). Methods: Medline, EMBASE, and CENTRAL were systematically searched for studies that reported MVS outcomes according to the presence or absence of preAF. Data were independently extracted by two investigators; a meta-analysis was conducted according to predefined clinical endpoints. Studies including patients undergoing concomitant atrial fibrillation surgery were excluded. Results: Ten observational studies met the criteria for inclusion, including a total of 4279 patients. Of these, 1896 (44.3%) presented with preAF. There was a non-significant trend towards increased perioperative mortality in patients with preAF (odds ratio [OR] 1.61; 95% Confidence Interval [CI], 0.97–2.67; p = 0.07). Pre-AF was associated with stroke on follow-up (hazard ratio [HR] 3.70; 95% CI, 1.36–10.09; p = 0.003) and cardiac death (HR 4.29; 95%, CI, 1.28–14.37; p = 0.02). Analysis of pooled data from these studies also indicated that preoperative AF was independently associated with late mortality (HR 1.84; 95% CI, 1.40–2.42; p < 0.001). There was no association of preAF with NYHA III/IV at follow-up (HR 1.21; 95% CI, 0.56–2.63; p = 0.63). Conclusions: PreAF is associated with an increased risk of late mortality after MVS, in part due to the increased risk of cardioembolic complications.
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