Author + information
- Angelo Biviano1,
- Tamim Nazif2,
- Jose Dizon3,
- Hasan Garan1,
- Aaron Crowley4,
- S. Malaisrie5,
- Raj Makkar6,
- Vinod Thourani7,
- Michael Mack8,
- Wilson Y. Szeto9,
- William Fearon10,
- Martin Leon11 and
- Susheel Kodali12
- 1Columbia University Medical Center, New York, New York, United States
- 2NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, New York, United States
- 3Cardiovascular Research Foundation, Columbia University Medical Center, New York, New York, United States
- 4Cardiovascular Research Foundation, Queens, New York, United States
- 5Northwestern University Feinberg School of Medicine, Chicago, Illinois, United States
- 6Cedars-Sinai Medical Center, Los Angeles, California, United States
- 7Emory University Hospital Midtown, Atlanta, Georgia, United States
- 8The Heart Hospital Baylor Plano, Plano, Texas, United States
- 9University of Pennsylvania, Philadelphia, Pennsylvania, United States
- 10Division of Cardiovascular Medicine, Stanford University School of Medicine, Stanford, California, United States
- 11Columbia University Medical Center/NewYork-Presbyterian Hospital, New York, New York, United States
- 12Columbia, Hastings on Hudson, New York, United States
Atrial fibrillation or flutter (AF) has been associated with worse outcomes in many cardiovascular disease states, but there are scant data in STS-defined intermediate-risk aortic stenosis (AS) patients undergoing transcatheter or surgical aortic valve replacement (TAVR/SAVR).
Data were evaluated in 2699 intermediate-risk patients who underwent TAVR or SAVR in either the PARTNER (Placement of AoRTic TraNscathetER Valve) 2A or S3i Trials. Clinical outcomes at 1-year and 2-years were compared in patients by baseline and discharge rhythm: sinus rhythm (SR) versus AF.
For the 1905 TAVR patients, 3.3% manifested SR baseline/AF discharge, 17.6% AF baseline/AF discharge, and 79.1% SR baseline/SR discharge. The 794 SAVR patients developed more AF by discharge: 14.2% SR/AF, 14.1% AF/AF, and 71.7% SR/SR. Total mortality at 1-year was increased in AF patients for both groups: TAVR= 15.9% SR/AF vs 7.6% SR/SR, p=0.02; SAVR= 16.0% SR/AF vs. 8.9% SR/SR, p=0.02. Mortality occurring between 1-year and 2-year follow-up was also higher in the AF groups: TAVR= 4.7% AF/AF vs 2.2% SR/SR, p=0.02; SAVR= 11.0% SR/AF vs. 5.7% SR/SR, p=0.053. The 1-year composite endpoint of death, rehospitalization, and stroke was higher in the AF groups: TAVR= 36.5% SR/AF* vs 25.7% AF/AF** vs. 20.7% SR/SR, p=0.002* and p=0.05** vs. SR/SR; SAVR= 41.2% AF/AF vs. 22.8% SR/SR, p<0.0001. AF patients manifested significantly higher rates of total mortality and the composite endpoint at 2-year follow-up (Figure).
Intermediate-risk AS patients undergoing TAVR manifest less AF by discharge than SAVR patients. For both TAVR and SAVR patients, the presence of AF at discharge is associated with worse outcomes at 1-year and 2-year follow-up.
STRUCTURAL: Valvular Disease: Aortic