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Page 8 of 15 Novotny et al. Vessel Plus 2022;6:51 https://dx.doi.org/10.20517/2574-1209.2021.139

Table 2. Outcomes of r-SAVR and viv-TAVR in patients with and without pre-operative AF/AFL
r-SAVR viv-TAVR
AF/AFL No AF/AFL P- AF/AFL No AF/AFL P-
Total Total
(42.4%) (57.6%) value (50.4%) (49.6%) value
Permanent stroke (%) 2.4 3.5 1.7 0.6406 0.8 1.5 0.0 1.0000
Renal failure (%) 12.7 13.8 11.9 0.6817 10.1 10.8 9.4 0.7925
DSWI (%) 1.0 1.2 0.9 1.0000 0.0 0.0 0.0 -
Prolonged ventilation (%) 5.9 10.3 2.5 0.0307 6.2 4.6 7.8 0.4949
Repeat procedure (%) 0.0 0.0 0.0 - 0.0 0.0 0.0 -
Major complication (%) 18.1 23.0 14.4 0.1143 14.7 16.9 12.5 0.4785
30-day operative 2.9 2.3 3.4 0.7034 4.7 4.6 4.7 1.0000
mortality (%)
Composite endpoint (%) 18.5 24.1 14.4 0.0764 17.1 18.5 15.6 0.6684
In-hospital death (%) 2.9 2.3 3.4 0.7021 4.7 4.6 4.7 1.0000
LOS (%) 11.86 ± 13.47 ± 11.73 10.68 ± 8.69 0.0628 8.27 ± 9.54 ± 9.39 6.98 ± 10.38 0.1454
10.16 9.94
Post-operative days (%) 10.77 ± 12.74 ± 11.23 9.31 ± 8.05 0.0167 7.22 ± 8.49 ± 9.11 5.92 ± 9.75 0.1246
9.65 9.49
Conversion to SAVR (%) - - - - 0.0 0.0 0.0 -
30-day readmission (%) 16.6 19.5 14.4 0.3287 12.4 15.4 9.4 0.3005
AKI (%) 12.7 13.8 11.9 0.6817 9.3 9.2 9.4 0.9775
Cardiac arrest (%) 9.3 14.9 5.1 0.0161 3.9 4.6 3.1 1.0000
Major bleeding (%) 5.9 5.8 5.9 0.9555 2.3 1.5 3.1 0.6135
Prosthetic valve 2.0 0.0 3.4 0.1412 0.0 0.0 0.0 -
endocarditis (%)
TIA (%) 0.0 0.0 0.0 - 0.8 1.5 0.0 1.0000
Vascular complications 0.0 0.0 0.0 - 0.0 0.0 0.0 -
(%)
MI (%) 1.5 0.0 2.5 0.2728 4.7 4.6 4.7 1.0000
Major stroke (%) 2.9 2.3 3.4 0.7127 2.3 3.1 1.6 1.0000

r-SAVR: Redo surgical aortic valve replacement; viv-TAVR: valve-in-valve transcatheter aortic valve replacement; AF/AFL: atrial
fibrillation/flutter; DSWI: deep sternal wound infection; LOS: length of stay; AKI: acute kidney injury; TIA: transient ischemic attack; MI:
myocardial infarction.

Table 3. Multivariable model findings for STS MM composite endpoint
Odds ratio 95% confidence interval P-value
Pre-operative AF/AFL 1.23 0.66-2.28 0.512
Admission type: elective vs. urgent 0.55 0.27-1.10 0.093
Race: black vs. other 2.89 1.01-8.32 0.049
Insurance: commercial vs. medicare 0.66 0.27-1.59 0.632
Insurance: medicaid/other vs. medicare 0.66 0.11-4.09 0.632
Age 1.01 0.98-1.04 0.636
Elixhauser mortality score 1.07 1.04-1.10 < 0.0001

Model C-index = 0.753. STS: Society of thoracic surgeons; MM: major morbidity; AF/AFL: atrial fibrillation/flutter.

DISCUSSION
This novel retrospective, observational database analysis assessed the impact of preoperative AF/AFL on
risk-adjusted clinical and resource outcomes for patients undergoing r-AVR procedures while holding other
factors constant. While these arrhythmic conditions have previously been evaluated in first-time AVR, there
was a paucity of data regarding AF/AFL in r-AVR candidates. Holding other risk factors constant, this r-