Conversion to sinus rhythm does not improve long-term survival after valve surgery:: insights from a 20-year follow-up study

Objective: Atrial. fibrillation (AF) is frequently associated with valvular heart disease and a common complication of valve surgery. Its contribution to long-term mortality and morbidity remains debated. Our objective was to determine the impact of AF on tong-term mortality and embolic complications after valvular surgery and the benefit of conversion to sinus rhythm. This may provide insight to the clinical advantages of surgical anti-AF procedures. Methods: Data concerning rhythm status, mortality and embolic complications were prospectively collected for 5466 patients with valve surgery. Patients had surgery between 1979 and 2003. Follow-up was complete and all patients had a yearly EKG. Results: Patients with preoperative AF had poorer tong-term survival than patients without preoperative AF (20-year survival 23.7 and 33.4%, respectively, P < 0.0001). However, preoperative AF was not an independent risk factor of tong-term mortality (HR=1.04, P=0.6). In patients with preoperative sinus rhythm, postoperative development of AF had an impact on tong-term mortality (HR=1.46, P=0.0012). In patients with preoperative AF, postoperative rhythm did not influence mortality when adjusted for other variables (AF vs. sinus rhythm, HR=1.07, P=0.5709). Mitral valve surgery (HR=1.55, P=0.0270) but not preoperative or postoperative AF had a significant impact on the advent of embotic complications. Conclusions: The conversion to sinus rhythm did not improve long-term survival or reduce the incidence of embotic complications after valve surgery. Patients with preoperative AF had poorer survival than patients without preoperative AF. AF may be a marker of advanced disease in these patients. (c) 2005 Elsevier B.V. All rights reserved.