Heart Valve Surgery Research Articles

The effect of two different doses of remifentanil on postoperative pain and opioid consumption after cardiac surgery--a randomized controlled trial.

Remifentanil, an ultra-short-acting opioid, provides intensive analgesia without prolonged respiratory depression and is widely used in cardiac surgery. Diminished dosing may also offer stable hemodynamics, even during sternotomy and sternal retraction. However, increased postoperative pain and induced opioid tolerance after remifentanil dosing during abdominal surgery was reported. We tested whether remifentanil 0.3μg/kg/min infusion increased postoperative opioid consumption and pain compared to 0.1μg/kg/min dosing. Ninety coronary artery bypass grafting or heart valve surgery patients were randomized to remifentanil 0.1μg/kg/min or 0.3μg/kg/min infusions during surgery. All patients received oxycodone bolus 0.15μg/kg postoperatively, and patient-controlled analgesia (PCA) with oxycodone thereafter. Postoperative pain was estimated thrice daily by visual analogue scale, and 48-h opioid consumption was recorded from the PCA-device. Total remifentanil dosing was 64μg/kg in the higher and 22μg/kg in the lower dosing group during the 3-h cardiac operations. Mean postoperative opioid consumption was 107 (SD 36)mg in the lower and 104 (SD 33)mg in the higher dose remifentanil groups. Postoperative pain did not differ between groups, at rest or during deep breathing, at any time (P=0.110 and 0.941, respectively). Remifentanil 0.3μg/kg/min infusion did not increase postoperative pain or opioid consumption after cardiac surgery compared to the 0.1μg/kg/min infusion. Remifentanil infusion 0.1-0.3μg/kg/min during cardiac surgery was safe, with no exaggerated postoperative pain or opioid consumption.

Cardiac rehabilitation and survival in a large representative community cohort of Dutch patients.

To assess the effects of multi-disciplinary cardiac rehabilitation (CR) on survival in the full population of patients with an acute coronary syndrome (ACS) and patients that underwent coronary revascularization and/or heart valve surgery. Population-based cohort study in the Netherlands using insurance claims database covering ∼22% of the Dutch population (3.3 million persons). All patients with an ACS with or without ST elevation, and patients who underwent coronary revascularization and/or valve surgery in the period 2007-10 were included. Patients were categorized as having received CR when an insurance claim for CR was made within the first 180 days after the cardiac event or revascularization. The primary outcome was survival time from the inclusion date, limited to a total follow-up period of 4 years, with a minimum of 180 days. Propensity score weighting was used to control for confounding by indication. Among 35 919 patients with an ACS and/or coronary revascularization or valve surgery, 11 014 (30.7%) received CR. After propensity score weighting, the adjusted hazard ratio (HR) associated with receiving CR was 0.65 (95% CI 0.56-0.77). The largest benefit was observed for patients who underwent coronary artery bypass grafting (CABG) and/or valve surgery (HR = 0.55, 95% CI 0.42-0.74). In a large and representative community cohort of Dutch patients with an ACS and/or intervention, CR was associated with a substantial survival benefit up to 4 years. This survival benefit was present regardless of age, type of diagnosis, and type of intervention.

High readmission rate after heart valve surgery: A nationwide cohort study

BackgroundAfter heart valve surgery, knowledge on long-term self-reported health status and readmission is lacking. Thus, the optimal strategy for out-patient management after surgery remains unclear. MethodsUsing a nationwide survey with linkage to Danish registers with one year follow-up, we included all adults 6–12months after heart valve surgery irrespective of valve procedure, during Jan–June 2011 (n=867). Participants completed a questionnaire regarding health-status (n=742), and answers were compared with age- and sex-matched healthy controls. Readmission rates and mortality were investigated. ResultsAfter valve surgery, the self-reported health was lower (Short Form-36 (SF-36) Physical Component Scale (PCS): 44.5 vs. 50.6 and Mental Component Scale (MCS): 51.9 vs. 55.0, p<0.0001) and more were physically sedentary compared with healthy controls (11.1% vs. 15.2%). Clinical signs of anxiety and depression were present in 13.6% and 13.8%, respectively (Hospital Anxiety and Depression Scale score≥8). Twelve months following discharge, 483 persons (56%) were readmitted. Readmission was associated with lower self-reported health (SF-36 PCS: 46.5 vs. 43.9, and MCS 52.2 vs. 50.7). Higher age (hazard ratio (95% CI): 1.3 (1.0–1.6)), male sex (1.2 (1.0–1.5)), mitral valve surgery (1.3 (1.0–1.6)), and infective endocarditis after surgery (1.8 (1.1–3.0), p: 0.01) predicted readmission, whereas higher age (2.3 (1.0–5.4)), higher comorbidity score (3.2 (1.8–6.0)), and infective endocarditis after surgery (3.2 (1.2–8.9)) predicted mortality. Conclusions6–12months after heart valve surgery the readmission rate is high and the self-reported health status is low. Readmission is associated with low self-reported health. Therefore, targeted follow-up strategies post-surgery are needed.

Echocardiographic evaluation of cardiac function response to removal of aortic stenosis: Surgical and trans-catheter aortic valve implantation (TAVI)

&lt;p&gt;Aortic stenosis (AS) is the commonest valve disease in the&lt;/p&gt;&lt;p&gt;West, with a prevalence varying between 0.02% in adults&lt;/p&gt;&lt;p&gt;under 44 years and 3-9% in those over 80 years of age &lt;span&gt;1, 2&lt;/span&gt;. The&lt;/p&gt;&lt;p&gt;disease may remain “silent” and hence unnoticed for years,&lt;/p&gt;&lt;p&gt;particularly in the elderly with naturally limited exercise. With the&lt;/p&gt;&lt;p&gt;development of symptoms, patients may carry a mortality of&lt;/p&gt;&lt;p&gt;36-52%, 52-80% and 80-90% at 3, 5 and 10 years, respectively&lt;/p&gt;&lt;p&gt;if left untreated, with a potential high risk of sudden death &lt;span&gt;3&lt;/span&gt;.&lt;/p&gt;&lt;p&gt;Surgical aortic valve replacement (SAVR) used to be the only&lt;/p&gt;&lt;p&gt;effective treatment for severe AS, being the second indication&lt;/p&gt;&lt;p&gt;for open heart surgery after coronary artery bypass grafting&lt;/p&gt;&lt;p&gt;(CABG) &lt;span&gt;4&lt;/span&gt;. Trans-catheter aortic valve implantation (TAVI) is a&lt;/p&gt;&lt;p&gt;recently developed procedure which aims at non-surgical AVR&lt;/p&gt;&lt;p&gt;in patients with severe, symptomatic and calcified AS who&lt;/p&gt;&lt;p&gt;are at high surgical risk because of either poor left ventricular&lt;/p&gt;&lt;p&gt;(LV) function, ejection fraction (EF) &amp;lt;50%, or other significant&lt;/p&gt;&lt;p&gt;co-morbidities e.g. age &amp;gt;80 years, previous CABG surgery and/&lt;/p&gt;&lt;p&gt;or aorta or other heart valve surgery, impaired kidney function,&lt;/p&gt;&lt;p&gt;chronic obstructive pulmonary disease (COPD) or pulmonary&lt;/p&gt;&lt;p&gt;hypertension &lt;span&gt;5&lt;/span&gt;. Currently, this technique is not recommended&lt;/p&gt;&lt;p&gt;in bicuspid AS patients due to the risk of incomplete and&lt;/p&gt;&lt;p&gt;suboptimal deployment of the aortic prosthesis [6]. TAVI&lt;/p&gt;&lt;p&gt;avoids open heart surgery and hence is likely to protect&lt;/p&gt;&lt;p&gt;myocardial function. The purpose of this paper is to review the&lt;/p&gt;&lt;p&gt;echocardiographic evaluation of LV, right ventricular (RV), and&lt;/p&gt;&lt;p&gt;left atrial (LA) function response to SAVR and TAVI for AS.&lt;/p&gt;

What is the value of a nurseled clinic for patients with replacement heart valves?

Background: Long-term regular specialist surveillance is recommended to reduce the risks of complications arising after heart valve surgery. This could be delivered by a nurse-led valve clinic. Aims: To determine how often clinical events are detected within a nurse-led valve clinic and how often a cardiologist or sonographer is required. Methods: Nurse-led valve clinic outcomes and events were analysed over 48 months from 2010 to 2013. An endpoint was any new symptom or event or the need for an unscheduled echocardiogram. Results: There were 544 visits in 206 patients. Endpoints were found in 178 visits (33%). A cardiologist was required in 100 visits (18%) to see the patient in 27 and give advice in 73. Another clinician was needed in 8 visits. Unscheduled echocardiography was required in 70 (13%) visits. Conclusion: A nurse-led valve clinic is feasible. Clinical endpoints are detected frequently and enhanced long-term care can be safely provided. Review or discussion with a cardiologist or unscheduled echocardiography is sometimes required which supports the model of a multidisciplinary clinic.

Gender differences in outcomes following cardiac surgery: implications for managing patients with mitral valve disease.

This review summarizes the differences in clinical outcomes following cardiac surgery according to gender. Women comprise a large proportion of patients presenting with coronary artery or valvular heart disease. Although it is well known that women have poorer survival following bypass surgery compared with men, more recent data confirm that women also have poorer outcomes after heart valve surgery. Women are also more likely to receive mitral valve replacement instead of repair, when compared with men. These divergent outcomes are because of many factors, including valve disease and clinical presentation, which may result in delayed surgical referral in women. Factors that result in poorer outcomes following heart valve surgery, including mitral valve surgery, between men and women remain incompletely understood. These may relate to differences in clinical presentation, valve morphology, and physiology. Further research is needed to clarify differences in heart valve outcomes according to gender.

Abstract W P197: Temporal Association between Infective Endocarditis and Stroke

Introduction: Stroke is a frequent complication of infective endocarditis (IE). However, there is uncertainty regarding the temporal association between IE and stroke. Methods: Using claims data from nonfederal acute care hospitals in California, we identified patients hospitalized for IE between July 1, 2007 and June 30, 2011. We used validated diagnosis codes to identify a primary composite outcome of ischemic or hemorrhagic stroke during discrete 1-month periods in the 6 months before and 6 months after the diagnosis of IE. We then compared the likelihood of stroke in these 1-month periods to the corresponding 1-month periods 2 years prior, which was considered each patient’s baseline risk of stroke. In a secondary analysis, ischemic and hemorrhagic stroke were evaluated separately. Absolute risks and odds ratios (ORs) were calculated using a Mantel-Haenszel estimator for matched data. Results: Among 17,926 patients with IE, 2,275 strokes occurred within the 12-month period surrounding the diagnosis of IE, compared to 174 strokes during the corresponding period 2 years prior. The risk of stroke was the highest in the one month after diagnosis of IE as compared to the 1-month period 2 years prior (1640 versus 17 strokes). This equaled an absolute risk increase of 9.1% (95% CI 8.6-9.5) and an odds ratio of 96.5 (95% CI 59.6-155.6). Stroke risk was significantly increased from 4 months before to 5 months after the diagnosis of IE. Similarly, there was an increase in ischemic stroke risk from 4 months before to 3 months after IE, and an increase in hemorrhagic stroke risk from 4 months before to 5 months after IE. In all analyses, the increase in risk was highest in the 1 month after IE diagnosis. Conclusions: Patients with IE have a dramatically increased risk of ischemic and hemorrhagic stroke. The risk of stroke was highest in the one month after IE diagnosis and persisted for several months afterward. Furthermore, stroke risk was elevated beginning 4 months prior to the diagnosis of IE, which may reflect risk factors that can lead to both stroke and IE (e.g., heart valve surgery) or post-stroke factors that may predispose to IE (e.g., post-stroke immunosuppression or use of central venous catheters after stroke).

Anticoagulation in patients with mechanical heart valves: follow the guidelines!

Heart valve surgery has been one of the great leaps forward in the management of heart disease in the last 60 years. Thanks to technical developments, artificial heart valves were constructed that prove to be competent and durable. Besides the risk of infective endocarditis, thromboembolism from the foreign body structures of the prosthesis remains a major problem, which can be effectively reduced, but not annihilated by the use of oral anticoagulants. For nearly all patients on oral anticoagulants, bleeding is the most common problem. The only available and proven effective oral anticoagulants for carriers of mechanical heart valve prosthesis are the vitamin-K antagonists (VKA). They need intensive monitoring of the anticoagulation status through the dense network of thrombosis clinics in the Netherlands. Recently, non-VKA direct-acting oral anticoagulants were introduced, which are safer and more effective than VKA in stroke prevention in atrial fibrillation [1]. They have also been tested in patients undergoing mechanical heart valve replacement and in those with recent implantation, but here they failed in efficacy and safety in comparison with VKA [2]. Thus, VKA remains the standard of anticoagulation care for patients carrying artificial heart valves.

Heart valve surgery in patients with homozygous sickle cell disease: A management strategy

Background:Patients with the homozygous sickle cell disease have increased perioperative mortality. Some indications like heart valve surgery, may justify an exchange blood transfusion to reduce the proportion of hemoglobin S (HbS) and complications.Subjects and Methods:We report two female cases aged 20 and 27, of African origin with homozygous sickle cell anemia who underwent heart valve surgery to treat mitral valve regurgitation. This presentation describes the perioperative considerations including anesthesia and postoperative care.Results:A partial exchange blood transfusion decreased HbS levels from respectively, 90% and 84%, 9% to 27% and 34%, and simultaneously treated the anemia. Neither sickling crisis nor acidosis occurred in any patient, and no special postoperative complication occurred. Average hospital stay was 10 days. Currently, the two patients remain alive and free of cardiac symptoms.Discussion:Although the presence of sickle cell disorders is associated with increased risk of sickling and thus vaso-occlusive complications, they should not be taken as a contraindication for heart valve surgery. Nevertheless, monitoring of certain parameters such as venous, arterial oxygen content, pH, and body temperature is mandatory for a better outcome. Furthermore, preoperative exchange transfusion has a positive influence on the outcome of surgery and on the survival of patients undergoing heart valves surgery. Avoiding intraoperative hypoxia, hypothermia, and vaso-constrictive agents, minimizing HbS levels with preoperative exchange transfusion, and ensuring a stress-free environment with the judicious use of sedatives made surgery relatively safe in these cases.

The relationship between competition and quality in procedural cardiac care.

Anesthesiologists are frequently involved in efforts to meet perioperative quality metrics. The degree to which hospitals compete on publicly reported quality measures, however, is unclear. We hypothesized that hospitals in more competitive environments would be more likely to compete on quality and thus perform better on such measures. To test our hypothesis, we studied the relationship between competition and quality in hospitals providing procedural cardiac care and participating in a national quality database. For hospitals performing heart valve surgery (HVS) and delivering acute myocardial infarction (AMI) care in the Hospital Compare database, we assessed the degree of intrahospital competition using both geographical radius and federally defined metropolitan statistical area (MSA) to determine the degree of intrahospital competition. For each hospital, we then correlated the degree of competition with quality measure performance, mortality, patient volume, and per-patient Medicare costs for both HVS and AMI. Six hundred fifty-three hospitals met inclusion criteria for HVS and 1898 hospitals for AMI care. We found that for both definitions of competition, hospitals facing greater competition did not demonstrate better quality measure performance for either HVS or AMI. For both diagnoses, competition by number of hospitals correlated positively with cost: partial correlation coefficients = 0.40 (0.42 for MSA) (P < 0.001) for HVS and 0.52 (0.47 for MSA) (P < 0.001) for AMI. An analysis of the Hospital Compare database found that competition among hospitals correlated overall with increased Medicare costs but did not predict better scores on publicly reported quality metrics. Our results suggest that hospitals do not compete meaningfully on publicly reported quality metrics or costs.

Age, Creatinine and Ejection Fraction Score in Brazil: Comparison with InsCor and the EuroSCORE.

BackgroundRisk scores for cardiac surgery cannot continue to be neglected.ObjectiveTo assess the performance of “Age, Creatinine and Ejection Fraction Score” (ACEF Score) to predict mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery, and to compare it to other scores.MethodsA prospective cohort study was carried out with the database of a Brazilian tertiary care center. A total of 2,565 patients submitted to elective surgeries between May 2007 and July 2009 were assessed. For a more detailed analysis, the ACEF Score performance was compared to the InsCor’s and EuroSCORE’s performance through correlation, calibration and discrimination tests.ResultsPatients were stratified into mild, moderate and severe for all models. Calibration was inadequate for ACEF Score (p = 0.046) and adequate for InsCor (p = 0.460) and EuroSCORE (p = 0.750). As for discrimination, the area under the ROC curve was questionable for the ACEF Score (0.625) and adequate for InsCor (0.744) and EuroSCORE (0.763).ConclusionAlthough simple to use and practical, the ACEF Score, unlike InsCor and EuroSCORE, was not accurate for predicting mortality in patients submitted to elective coronary artery bypass graft and/or heart valve surgery in a Brazilian tertiary care center.

Incidence, Severity, and Outcomes of Acute Kidney Injury in Octogenarians following Heart Valve Replacement Surgery.

Background. The study investigates the occurrence, severity, and outcomes of acute kidney injury (AKI) in octogenarians following heart valve surgery. Methods. All patients, age >80 years, not on dialysis and without kidney transplant, undergoing heart valve replacement at Mayo Clinic, Rochester, in the years 2002-2003 were enrolled. AKI was diagnosed based on AKIN criteria. Results. 209 octogenarians (88.0% aortic valve, 6.2% mitral valve, 1.0% tricuspid valve, and 4.8% multivalve) with (58.4%) and without CABG were studied. 34 (16.3%) had preexisting CKD. After surgery, 98 (46.8%) developed AKI. 76.5% of the AKI were in Stage 1, 9.2% in Stage 2, and 14.3% in Stage 3. 76.5% CKD patients developed AKI. Length of hospital stay was longer for AKI patients. More AKI patients were discharged to care facilities. Patient survival at 30 days and 1 year for AKI versus non-AKI was 88.8 versus 98.7%, p = 0.003, and 76.5 versus 88.3%, p = 0.025, respectively. With follow-up of 3.94 ± 0.28 years, Kaplan-Meier analysis showed a reduced survival for AKI octogenarians. Preexisting CKD and large volume intraoperative fluid administration were independent AKI predictors. Conclusions. Nearly half of the octogenarians developed AKI after valve replacement surgery. AKI was associated with significant functional impairment and reduced survival.

EFFICACY OF CARPENTIER-EDWARDS PERICARDIAL PROSTHESES: A SYSTEMATIC REVIEW AND META-ANALYSIS.

The Carpentier-Edwards pericardial (CEP) prostheses are the type of bioprostheses most used worldwide. Although they were designed to minimize the rate of valve deterioration and reoperation, their clinical superiority over other prostheses models still lacks confirmation. The objective of this study was to evaluate its effectiveness. We performed a systematic review and meta-analysis in the PubMed, Embase, Cochrane, and Lilacs databases. Operative mortality, overall mortality and reoperation rates after heart valve surgery were compared between the use of CEP and other cardiac prostheses. Two independent reviewers screened studies for inclusion and extracted the data. Disagreements were resolved by consensus. The GRADE criterion was used to assess the evidence quality. A total of twenty-eight studies were selected, including 19,615 individuals. The studies presented a high heterogeneity and low quality of evidence what limited the reliability of the results. The pooled data from the selected studies did not demonstrate significant differences between CEP and porcine, pericardial or stentless prostheses regarding operative mortality, overall mortality and reoperation rates. However, the pooled data from 3 observational trials pointed out a higher risk for reoperation after valve replacement using CEP prostheses against mechanical prostheses (OR 4.92 [95 percent confidence interval 2.43-9.96]). The current data present in the literature still does not support a clinical advantage for the use of CEP prostheses over other bioprostheses. The quality of the studies in the literature is limited and further studies are needed to address if CEP prostheses will have a clinical advantage over other prostheses.

Prediction and prevention of pulmonary-pleural complications after heart valve surgery

Prediction and prevention of pulmonary-pleural complications after heart valve surgery

Intractable Hemolytic Anemia after Heart Valve Surgery

Heart valve surgery consists of valve replacement and repair. Both operations have been standard strategies for treating heart valve diseases worldwide, and are associated with excellent long-term clinical results. Hemolytic anemia after heart valve surgery, however, is a troublesome complication related to implanted prosthetic valves or rings.

The magic of sound waves in medicine

Echocardiography is an unavoidable tool in the evaluation of the cardiac system. It's role is as important as that of ECG. The basic principles of echocardiography is same as that of the ultrasonography. As the years progress lot of modifications has occurred with the modes of evaluation in echocardiography starting from the ancient M mode to the latest three dimensional mode. Along with the advancements in modes lots of upgradation has occurred in the functions of echo, which advanced from the identification of simple shape and structure of cardiac structures to identification of blood flow, its velocity and any mixing. On the other side various other forms of echo cardiography has been evolved like fetal echo, Transesophageal and intravascular echo. Among this three type transoesophageal echocardiography is the most common used in practice in case of open heart surgery or valve replacement. Depend on the position of probe over the chest the echocardiography is again in different axis. Even though it's an important diagnosis in cardiology it does not require any special preparations. The test can be carried out along with the routine visit. But the positioning of the patient and placement of the probe is usually important for a good quality image. Proper sound wave conduction is possible between the probe and the human body with the application of an electro conductive jelly.

Cardiopulmonary bypass duration as predictor of immediate results after cardiac surgery

It was analyzed the results of treatment of 152 patients who underwent heart valve surgery. Depending on cardiopulmonary bypass (CPB) duration patients were divided into 4 groups: the 1st--up to 90 min, the 2nd--90-120 min, the 3rd--120-180 min, the 4th--more than 180 min. Severity of initial comorbidities was comparable in all groups. It was revealed that CPB duration effects on intraoperative blood loss, incidence of acute renal failure, encephalopathy, use of inotropic and angiotonic support (p<0.05). Accession of CPB duration was associated with increased number of postoperative complications in all groups (p<0.05). "Critical periods" of CPB for every type of postoperative complications are defined.

Success rates and prognosis of heart valvuloplasty and valve replacement performed for elderly patients.

Objective:To analyze the success rates and prognosis of heart valvuloplasty and valve replacement for elderly patients, and to provide clinical evidence.Methods:A total of 1240 patients who received heart valve surgeries in our hospital from June 2004 to October 2014 were selected and retrospectively analyzed. They were divided into two groups based on age (60), and those older than 60 (Group B) suffered from rheumatic valvular heart disease and nonrheumatic valvular heart disease including degenerative valve disease. Mitral valve replacement (MVR), tricuspid valve replacement (TVR), aortic valve replacement (AVR), double valve replacement (DVR), mitral valvuloplasty (MVP) and tricuspid valvuloplasty (TVP) were performed by using bioprosthetic and mechanical valves. Before surgery, coronary angiography, coronary artery bypass grafting (CABG), left atrial thrombectomy, left atrial wall folding and radiofrequency ablation were conducted. For the patients younger than 60 (Group A) who had congenital heart disease, rheumatic valvular heart disease and valvular heart disease, MVR, AVR, DVR, MVP, TVP and closed cuspid commissurotomy were performed with bioprosthetic and mechanical valves. The two groups were then monitored.Results:The mortality rates of Group A and Group B were 2.7% (16 cases) and 3.1% (20 cases) respectively. They died mainly of malignant ventricular arrhythmias, multiple organ failure, left ventricular rupture, low cardiac output syndrome, acute renal failure, respiratory failure, upper gastrointestinal bleeding, mechanical valve failure and cerebrovascular accident. The two groups had significantly different application rates of bioprosthetic valve, times of auxiliary ventilation and hospitalization stay lengths (P<0.05), but left ventricular ejection fractions, left ventricular end-diastolic diameters (LVEDDs), mortality rates as well as times of aortic cross-clamping and cardiopulmonary bypass were similar (P>0.05). LVEDD, complicated coronary artery disease, CABG and grade of the New York Heart Association Functional Classification were independent risk factors for postoperative death.Conclusion:When heart valvuloplasty and valve replacement were performed for elderly patients, the success rate and prognosis could only be improved by optimizing preoperative preparation, shortening the times of cardiopulmonary bypass and aortic cross-clamping, and paying particular attention to myocardial protection and postoperative treatment.

Repeated heart valve surgery (review)

Repeated heart valve surgery (review)

Atorvastatin Reduces the Incidence of Postoperative Atrial Fibrillation in Statin-Naive Patients Undergoing Isolated Heart Valve Surgery: A Double-Blind, Placebo-Controlled Randomized Trial.

Atorvastatin has been demonstrated to reduce the incidence of postoperative atrial fibrillation (POAF) in patients undergoing cardiac surgery, but its effect on isolated heart valve surgery is unknown. In a randomized, double-blinded, placebo-controlled trial, 58 patients who underwent isolated heart valve surgery supported by on-pump cardiopulmonary bypass were randomly assigned to receive either placebo (n = 29) or 40 mg of atorvastatin once daily starting 3 days preoperatively and continuing within 5 days postoperatively (n = 29). A continuous monitoring tool and an electrocardiographic Holter monitoring were used for detecting the POAF (Clinical Trial Registration: www.clinicaltrials.gov; Unique Identifier: NTC02084069). The patients' median age was 49 years, and 67% were female. In all, 6 (21%) and 13 (45%) cases of POAF were observed in the atorvastatin and placebo groups, respectively (P = .050). The duration of AF before re-establishment of sinus rhythm was significantly lower in the atorvastatin group than in the placebo group (median of 70 vs 132 minutes, P = .026). The lengths of intensive care unit and hospital stay were comparable between the groups. The increase in postoperative white blood cell count was significantly lower in the atorvastatin group than in the placebo group (median of 1.5 vs 2.3 × 10(3)/µL, respectively, P = .019). After adjustment, the atorvastatin treatment was associated with a decrease in the risk of developing POAF (odds ratio 0.122, 95% confidence interval 0.027-0.548, P = .006). Perioperative treatment with 40 mg of atorvastatin is useful to decrease the incidence of POAF in the statin-naive patients undergoing isolated heart valve surgery.