Rezk, MaryTaha, AmarNielsen, Susanne JMartinsson, AndreasBergfeldt, LennartGuðbjartsson, TómasFranzén, StefanJeppsson, Anders2025-11-202025-11-202023-05-02Rezk, M, Taha, A, Nielsen, S J, Martinsson, A, Bergfeldt, L, Guðbjartsson, T, Franzén, S & Jeppsson, A 2023, 'Associations between new-onset postoperative atrial fibrillation and long-term outcome in patients undergoing surgical aortic valve replacement', European journal of cardio-thoracic surgery : official journal of the European Association for Cardio-thoracic Surgery, vol. 63, no. 5, ezad103. https://doi.org/10.1093/ejcts/ezad1031010-79401135316735d186c2a-e749-4fa0-9fba-0a4ddad41f6a36961335unpaywall: 10.1093/ejcts/ezad10385180267368https://hdl.handle.net/20.500.11815/7154© The Author(s) 2023. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.OBJECTIVES: Data on prognostic implications of new-onset postoperative atrial fibrillation (POAF) after surgical aortic valve replacement (SAVR) is limited. We sought to explore associations between POAF, early initiated oral anticoagulation (OAC) and long-term outcome after SAVR and combined SAVR + coronary artery bypass grafting (CABG). METHODS: This is a retrospective, population-based study including all isolated SAVR (n = 7038) and combined SAVR and CABG patients (n = 3854) without a history of preoperative atrial fibrillation (AF) in Sweden 2007-2017. Individual patient data were merged from 4 nationwide registries. Inverse probability of treatment weighting-adjusted Cox regression models were employed separately in SAVR and SAVR + CABG patients. The median follow-up time was 4.7 years (range 0-10 years). RESULTS: POAF occurred in 44.5% and 50.7% of SAVR and SAVR + CABG patients, respectively. In SAVR patients, POAF was associated with increased long-term risk of death [adjusted hazard ratio (aHR) 1.21 (95% confidence interval 1.06-1.37)], ischaemic stroke [aHR 1.32 (1.08-1.59)], any thromboembolism, heart failure hospitalization and recurrent AF. In SAVR + CABG, POAF was associated with death [aHR 1.31 (1.14-1.51)], recurrent AF and heart failure, but not with ischaemic stroke [aHR 1.04 (0.84-1.29)] or thromboembolism. OAC was dispensed within 30 days after discharge to 67.0% and 65.9%, respectively, of SAVR and SAVR + CABG patients with POAF. Early initiated OAC was not associated with reduced risk of death, ischaemic stroke or thromboembolism in any group of patients. CONCLUSIONS: POAF after SAVR is associated with an increased risk of long-term mortality and morbidity. Further studies are warranted to clarify the role of OAC in SAVR patients with POAF.1103387eninfo:eu-repo/semantics/openAccessAortic Valve/surgeryAtrial Fibrillation/etiologyBrain IschemiaHeart Failure/complicationsHumansPostoperative Complications/epidemiologyRetrospective StudiesRisk FactorsStroke/epidemiologyThromboembolism/etiology•Surgical aortic valve replacementPostoperative atrial fibrillationCoronary artery bypass graftingCardiology and Cardiovascular MedicinePulmonary and Respiratory MedicineSurgerySDG 3 - Good Health and Well-being/dk/atira/pure/researchoutput/researchoutputtypes/contributiontojournal/article10.1093/ejcts/ezad103