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[odds ratio (OR), 95% confidence interval (CI): 1.23, 0.66-2.28, P = 0.512] or READMIT (OR, 95%CI: 1.15, 0.60-
2.19, P = 0.681). Black race (OR, 95%CI: 2.89, 1.01-8.32, P = 0.049) and Elixhauser mortality score (OR, 95%CI:
1.07, 1.04-1.10, P < 0.0001) predicted MM risk. Cerebrovascular disease (OR, 95%CI: 2.54, 1.23-5.25, P = 0.012)
predicted READMIT risk, while viv-TAVR was protective compared to r-SAVR (OR, 95%CI: 0.44, 0.21-0.91, P =
0.027).

Conclusion: AF/AFL was not associated with risk-adjusted short-term r-AVR outcomes. Black race, Elixhauser
mortality score, and cerebrovascular disease predicted adverse outcomes.

Keywords: Atrial fibrillation, atrial flutter, aortic valve replacement

INTRODUCTION
Atrial fibrillation (AF) and atrial flutter (AFL) are common arrhythmias occurring in patients with valvular
[1-3]
disease, with 25% to 40% of severe aortic valve disease patients having comorbid AF . Both aortic stenosis
(AS) and AF are progressive diseases, and their prevalence increases with older age . Development of AF
[4]
may produce symptoms that lead to intervention for previously asymptomatic aortic valve pathology. The
definitive treatment for severe AS is aortic valve replacement (AVR); these procedures can be performed
either by a transcatheter AVR (TAVR) intervention or via surgical AVR (SAVR).

Pre-operative AF has been associated with poor outcomes following cardiac surgery and has previously
[5-7]
been studied in patients undergoing first-time AVR. The impact of AF on mortality following first-time
AVR is not clear as several studies report AF to be an independent predictor of mortality, while others did
not identify AF as a risk factor for mortality [1,8-11] . However, AF has been associated with various major
complications after first-time AVR. Following SAVR, there is an increased risk of adverse cerebrovascular
and cardiac events in patients with pre-existing AF . Post-TAVR, patients with AF have higher rates of
[9]
[1]
bleeding events, renal failure, and permanent pacemaker placement . AF patients also have increased
healthcare utilization requirements following first-time AVR, such as length of hospital stay and adjusted
[11]
healthcare costs .
While the effects of pre-existing atrial fibrillation or flutter on first-time SAVR and TAVR outcomes have
been well-studied, there is a paucity of data regarding the impact of these arrhythmias in repeat AVR
(r-AVR) procedures. Specifically, prosthetic valve failure is a significant concern following AVR
interventions; in these cases, r-AVR via redo SAVR (r-SAVR) or valve-in-valve (viv) TAVR (viv-TAVR) is
the standard of care . As a synopsis, this study addressed the knowledge gap regarding the impact of pre-
[12]
operative AF/AFL on risk-adjusted r-SAVR and viv-TAVR outcomes. Comparing r-AVR patients with and
without AF/AFL, this study’s primary outcomes of interest included 30-day readmission and a composite of
major complications and/or 30-day operative mortality. Additional secondary outcomes included mortality,
length of stay, and adverse cardiac, renal, neurologic, and vascular complications.

METHODS
Database description and ethical approval
This retrospective, observational cohort study was conducted to compare risk-adjusted r-SAVR and viv-
TAVR outcomes in patients with preoperative AF/AFL (AF/AFL+) and without pre-operative AF/AFL
(AF/AFL-). The New York State Statewide Planning and Research Cooperative System (SPARCS) database
was used for data collection. Developed in 1979, SPARCS is an all-payer reporting database that compiles
information from hospitals throughout New York State regarding demographics, diagnoses, therapeutic
interventions, and outcomes. Coordinated via the Department of Surgery (Dr. Pryor-Principal Investigator),