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J Thorac Cardiovasc Surg. 2018 Oct;156(4):1543-1549.e4. doi: 10.1016/j.jtcvs.2018.03.169. Epub 2018 Apr 18.

Postoperative atrial fibrillation is associated with increased morbidity and resource utilization after left ventricular assist device placement.

Author information

1
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va.
2
Inova Heart and Vascular Institute, Falls Church, Va.
3
Virginia Cardiac Services Quality Initiative, Virginia Beach, Va.
4
Division of Cardiothoracic Surgery, and Virginia Commonwealth University, Richmond, Va.
5
Division of Thoracic and Cardiovascular Surgery, University of Virginia, Charlottesville, Va. Electronic address: LJT9R@virginia.edu.

Abstract

BACKGROUND:

Postoperative atrial fibrillation (POAF) is a known risk factor for morbidity and mortality after cardiac surgery but has not been investigated in the left ventricular assist device (LVAD) population. We hypothesize that POAF will increase morbidity and resource utilization after LVAD placement.

METHODS:

Records were extracted for all patients in a regional database who underwent continuous-flow LVAD placement (n = 1064, 2009-2017). Patients without a history of atrial fibrillation (n = 689) were stratified by POAF for univariate analysis. Multivariable regression models calculated the risk-adjusted association of arrhythmias on outcomes and resource utilization.

RESULTS:

The incidence of new-onset POAF was 17.6%, and patients who developed POAF were older and more likely to have moderate/severe mitral regurgitation, a history of stroke, and concomitant tricuspid surgery. After risk adjustment, POAF was not associated with operative mortality or stroke but was associated with major morbidity (odds ratio [OR] 2.5 P = .0004), prolonged ventilation (OR 2.7, P < .0001), unplanned right ventricular assist device (OR 2.9, P = .01), and a trend toward renal failure (OR 2.0, P = .06). In addition, POAF was associated with greater risk-adjusted resource utilization, including discharge to a facility (OR 2.2, P = .007), an additional 4.9 postoperative days (P = .02), and 88 hours in the intensive care unit (P = .01).

CONCLUSIONS:

POAF was associated with increased major morbidity, possibly from worsening right heart failure leading to increased renal failure and unplanned right ventricular assist device placement. This led to patients with POAF having longer intensive care unit and hospital stays and more frequent discharges to a facility.

KEYWORDS:

atrial fibrillation; cost; resource utilization; ventricular assist device

PMID:
29801690
PMCID:
PMC6156995
[Available on 2019-10-01]
DOI:
10.1016/j.jtcvs.2018.03.169

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