Gender Differences in Predictors and Long-Term Mortality of New-Onset Postoperative Atrial Fibrillation Following Isolated Aortic Valve Replacement Surgery

Mariana Fragão-Marques, Jennifer Mancio, João Oliveira, Inês Falcão-Pires, Adelino Leite-Moreira, Mariana Fragão-Marques, Jennifer Mancio, João Oliveira, Inês Falcão-Pires, Adelino Leite-Moreira

Abstract

Purpose: Postoperative atrial fibrillation (POAF) after coronary artery bypass grafting (CABG) has been associated with increased risk of death in women but not in men. We aimed to explore predictors and long-term mortality in POAF following isolated aortic valve replacement (AVR) surgery in men and women.

Methods: This study included 379 severe aortic stenosis patients with no prior atrial fibrillation (AF) who underwent isolated AVR surgery. We used multiple logistic regression to investigate independent gender-specific predictors of new-onset POAF, and we performed Kaplan-Meier (KM) to determine the impact of POAF in long-term mortality according to gender.

Results: Advanced age and coronary artery disease prevalence were higher among POAF patients in both genders. On multiple analysis, increased postoperative peak lactate was independently associated with POAF in men, while lower mean aortic valve gradient was associated with POAF in women. Area under the curve (AUC) for the model was 0.77 [0.68-0.86] and 0.69 [0.60-0.78] for men and women, respectively. At 4-year follow-up, POAF was linked to increased risk of death in men but not in women.

Conclusion: In severe aortic stenosis, factors associated with POAF and its impact on mortality differed between genders, with an increased risk of death observed only in men.

Keywords: aortic stenosis; gender; mortality; postoperative atrial fibrillation; risk factors.

Figures

Fig. 1. Area under the ROC curve…
Fig. 1. Area under the ROC curve for the multivariate logistic regression model in men and women
Fig. 2. KM curves and respective survival…
Fig. 2. KM curves and respective survival probabilities between POSR and POAF patients for women (A) and men (B). (C) KM curves between women and men. KM: Kaplan–Meier; N: number of patients at follow-up; POAF: postoperative atrial fibrillation; POSR: postoperative sinus rhythm; SP: survival probability

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