Preoperative atrial fibrillation increases risk of thromboembolic events after left ventricular assist device implantation. Ann Thorac Surg 2013 Dec;96(6):2161-7
Date
09/17/2013Pubmed ID
24035302DOI
10.1016/j.athoracsur.2013.07.004Scopus ID
2-s2.0-84889248873 (requires institutional sign-in at Scopus site) 78 CitationsAbstract
BACKGROUND: Because no series has specifically analyzed the impact of preoperative atrial fibrillation (AF) on patients already at higher risk of thromboembolism after implantation of a left ventricular assist device (LVAD), we review our experience with these patients.
METHODS: Between July 2003 and September 2011, 389 patients (308 male) underwent implantation of a continuous flow LVAD at University of Michigan Hospital and Mayo Clinic. Median age at implant was 60 years (range, 18 to 79 years). Preoperative AF was present in 120 patients (31%). Outcomes were analyzed for the association of preoperative AF and postoperative thromboembolic (TE) events defined as stroke, transient ischemic attack, hemolysis, or pump thrombosis. Thromboembolic events occurring within the first 30 days were not counted.
RESULTS: One hundred thirty-eight TEs events occurred in 97/389 patients (25%) for an event rate of 0.31 TE events/patient-years of support. Freedom from a TE event in patients with preoperative AF was 62% at 1 year and 46% at 2 years compared with 79% and 72% at 1 and 2 years, respectively, in patients without preoperative AF (p < 0.001). Median survival was 10 months (maximum 7.2 years, total 439 patient-years). Preoperative AF did not decrease late survival at 1 and 2 years after LVAD implant (preop AF: 85% and 70% versus no preop AF: 82% and 70%, respectively; p = 0.55).
CONCLUSIONS: Patients with preoperative AF have a lower freedom from TE events after LVAD implant. While overall late survival was not significantly reduced in these patients, refinement in anticoagulation strategies after VAD implant may be required.
Author List
Stulak JM, Deo S, Schirger J, Aaronson KD, Park SJ, Joyce LD, Daly RC, Pagani FDMESH terms used to index this publication - Major topics in bold
AdolescentAdult
Aged
Atrial Fibrillation
Female
Follow-Up Studies
Heart Failure
Heart-Assist Devices
Humans
Incidence
Male
Michigan
Middle Aged
Preoperative Period
Prognosis
Retrospective Studies
Risk Factors
Survival Rate
Thromboembolism
Young Adult
