Background: Postoperative atrial fibrillation (POAF) is a recognised complication of cardiac surgery associated with adverse outcomes. Preoperative left atrial dysfunction is thought to be associated with the development of POAF. In our centre, transoesophageal echocardiography (TOE) is used as part of the work-up for patients undergoing mitral valve surgery and left atrial appendage velocity is routinely assessed by performing clinicians.
Aim: This study aimed to investigate the utility of left atrial appendage velocity (LAAV) in predicting development of POAF after mitral valve surgery.
Methods: A retrospective analysis of all patients undergoing mitral valve surgery in a single specialist cardiac centre in 2019 was performed. Case records were interrogated and demographic, procedural and outcome data collected. Patients without permanent AF with a valid preoperative transoesophageal echocardiogram were included. Differences in LAAV between patients developing POAF and those who did not were compared using t test.
Results: Of 171 patients undergoing mitral valve surgery in our centre, 77 had valid preoperative TOE with pulsed wave Doppler assessment of the LAAV. Mean age was 66.7 ± 11.6 years with F:M ratio 29:48. For those without pre-existing AF (n=50), the LAAV was significantly lower in those who developed POAF 44.7 ± 13 cm/s vs 51.6 ± 16 cm/s (p=0.05). Using a cut-off value for normal LAAV of >40 cm/s, those with reduced LAAV were more likely to develop POAF (56% vs 29.4%; p<0.05). There was a trend towards increased length of stay for patients who developed POAF, though this did not reach statistical significance.
Conclusions: Although this study was limited by the sample size, it suggests that lower LAAV is associated with the development of POAF in patients undergoing mitral valve surgery. Routine collection of LAAV could be used as an additional tool in stratifying higher risk patients as part of the preoperative decision-making process.
