Does minimal-access aortic valve replacement reduce the incidence of postoperative atrial fibrillation?

Abstract

As the most common sequela of cardiac valvular surgery, atrial fibrillation (AF) has an important impact on postoperative morbidity. Minimal-access aortic valve replacement (AVR), with purported benefits on operative outcomes, has emerged as an alternative to conventional AVR. We used meta-analysis to determine whether minimal access influences the incidence of postoperative AF after AVR. Further, we sought first to evaluate via sensitivity analysis the impact of any differences and to identify the sources of possible heterogeneity between studies; second, we sought to evaluate any indirect effect of minimal-access AVR on other surrogate outcomes related to postoperative AF. We identified 10 studies from 26 comparative randomized and nonrandomized reports that documented the primary outcome of interest: new-onset AF. Overall meta-analysis showed no significant difference between minimal-access and conventional AVR in the incidence of postoperative AF (odds ratio, 0.85; 2,262 patients; P=0.24; 95% confidence interval, 0.66-1.11). Nor were there any apparent differences in surrogate outcome measures of intensive care unit stay, total length of stay, or stroke among studies that displayed a notable difference in AF incidence between groups. Sensitivity analysis that included only high-quality studies similarly showed no significant difference in the incidence of AF and further showed several intraoperative variables as potential sources of heterogeneity between studies. Therefore, minimal access may not have a significant effect on postoperative AF. Future randomized studies must take into account the potential sources of heterogeneity identified here to better demonstrate any differences between the 2 approaches in the onset of AF.

Keywords: Aortic valve/surgery; aortic valve stenosis/surgery; atrial fibrillation/etiology/prevention & control; postoperative complications; surgical procedures, minimally invasive.

Figures

Fig. 1 Results of overall meta-analysis performed to compare the incidence of atrial fibrillation after minimal-access aortic valve replacement (mAVR) with the incidence after conventional aortic valve replacement (cAVR). The squares indicate point estimates of treatment effect (OR), with 95% confidence intervals (CI) indicated by horizontal bars. The size of the squares represents the weight attributed to each study, and the diamond represents the overall OR from the pooled studies listed with 95% CIs; the overall OR is significant (P ≤0.05) only if the diamond does not touch the central vertical line (outside the 95% CI). These data therefore indicate no significant difference between the mAVR group and the cAVR group in the incidence of atrial fibrillation.