Co-Author(s):
Namsik Yoon, MD
Min Chul Kim, MD
Ki Hong Lee, MD
Hyun Ju Yoon, MD
Kye Hun Kim, MD
Hyung wook Park, MD
Ju Han Kim, MD
Youngkeun Ahn, MD
Myung Ho Jeong, MD
Jeong Gwan Cho, MD
Chonnam National University Hospital
Department of Cardiovascular Medicine, Chonnam National University Hospital, 42 Jaebongro, Dong-gu, Gwangju, 61469, South Korea
Introduction | Objectives: There have been evidences that atrial fibrillation (AF) altered outcomes after transcatheter aortic valve implantation (TAVI) and surgical aortic valve replacement (SAVR) in severe aortic stenosis (AS). However, there was little studies that compared the clinical outcome directly between TAVI and SAVR according to AF. We compared the incidence of AF in aortic valve replacement according to the method of management and how AF would impact their outcomes
Methods: A total of 221, severe AS patients were enrolled from January 2016 to December 2019. Among them, 100 patients were undergone TAVI and 121 were undergone SAVR. We investigated the incidence of AF and outcomes according to the AF occurrence before and after propensity score (PS) matching for 1-year. The clinical outcomes were defined as death, stroke, admission due to heart failure, and implantation of a permanent pacemaker. The net clinical outcome was composed of death, stroke, and heart failure
Results: The baseline characteristics were different before PS matching. However, it was similar after PS matching. As well as post-procedural or post-operative AF(23% vs. 55.4%, P=0.001) , the new onset AF incidence was significantly higher in the SAVR group before PS matching (6.0% vs 40.5%, P< 0.001 ) and after PS matching (7.5% vs 35.6%, P=0.001 ). Post-operative AF had worse impact for heart failure and net clinical outcome in the SAVR group (log rankP =0.049, P=0.033) . Post-procedural AF in TAVI group also had worse impact for admission due to heart failure (log rankP =0.010). TAVI and SAVR did not show significant difference in net clinical outcomes for 1 year follow-up (log rank P =0.763).
Conclusions: AF had worse impact for both TAVI and SAVR after PS matching. AF occurrence was significantly higher in SAVR group. Therefore, TAVI might be favorable option for severe AS patients who had high risk for AF development or previous AF.
AFS 2021-33