Significance of Isolated Postoperative Atrial Fibrillation in Thoracic Aortic Aneurysm Repair

Objective

While postoperative atrial fibrillation (POAF) has been shown to be associated with worse survival after thoracic aortic surgery, its effect on outcomes independently from other postoperative complications is not well understood.

Methods

This is a single-center retrospective study of patients who underwent open thoracic aortic aneurysm repair between March 2005 and March 2021. POAF was defined as new-onset atrial fibrillation (AF) that developed during the index hospital stay. Patients with preoperative AF were excluded. Postoperative major complications included reoperation for bleeding, respiratory failure, acute renal failure, and stroke. Variables associated with POAF were analyzed with multivariable regression. Survival of patients without major complications was compared between patients without AF to patients with POAF after propensity score matching for baseline and intraoperative characteristics.

Results

Of 1,454 patients, 520 (35.8%) were observed to have POAF. Patients with POAF had a higher rate of postoperative major complications than those without AF (20.2% vs. 12.2%, p<0.001). Ten year survival was 82.0% in patients with POAF and 87.0% in patients without AF (p=0.008). In the cohort of patients without complications, 10-year survival was similar between patients with and without POAF after propensity score matching (83.6% vs. 83.8%, p=0.75).

Conclusions

POAF is common after open proximal thoracic aortic aneurysm repair. While development of major postoperative complications is associated with POAF and decreased long-term survival, isolated POAF does not appear to influence long-term survival.