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Tummala et al. Vessel Plus 2022;6:17 https://dx.doi.org/10.20517/2574-1209.2021.114 Page 7 of 15

Filardo et al. [45] 2010 1039 380 (37) Y (concomitant CABG)
*Not specific to AS

Comparison of postoperative SAVR AF rates. SAVR: Surgical aortic valve replacement; AF: atrial fibrillation; AS: aortic stenosis; POAF: postoperative atrial fibrillation; CABG: coronary artery bypass graft; Y/N:
yes/no.

fibrillation in patients stratified by type of TAVR procedure. They identified that new-onset AF was most commonly found in the transapical TAVR (53%)
subgroup, which was significantly greater than the transaortic TAVR (33%) and transfemoral TAVR (14%) subgroups.

SAVR sternotomy vs. mini SAVR
Over the past two decades, minimally invasive cardiac surgical procedures have started to replace traditional sternotomy to reduce surgical complications.
Given that new-onset POAF is one of the major complications following cardiac surgery, it is essential to see how minimally invasive surgical procedures
impact POAF development. While minimally invasive mitral valve surgery has been shown to be associated with lower rates of POAF than conventional full
sternotomy, the data is less clear in terms of surgical aortic valve replacement. Some studies have shown significantly lower rates of POAF in the mini SAVR
procedures in comparison to traditional sternotomy (10.2% vs. 30.6%; P < 0.05) . However, numerous other studies have shown no significant difference in
[48]
[49]
POAF incidence between minimally invasive and full sternotomy surgical approaches . Given the conflicting data, more research is needed into the safety
and efficacy of minimally invasive SAVR procedures.

NEW-ONSET POAF OUTCOMES
Atrial fibrillation is a common postoperative outcome after aortic valve replacement in both surgical and transcatheter approaches. As many as 64% of patients
[26]
experience new-onset of atrial fibrillation after SAVR and 32% experience new-onset after TAVR . Given the high incidence of POAF, several studies have
looked at the associations and the predictive value of POAF for other adverse outcomes. These studies have shown that POAF is a severe postoperative
outcome associated with more cardiovascular events, a longer length of hospital stay, and an overall higher morbidity and mortality rate. These effects will be
discussed in the following paragraphs.

Short-term
SAVR outcomes
Although no association has been found between POAF and increased in-hospital or 30-day mortality compared to no new AF (1.5% vs. 1.0%; P = 0.48), POAF
has been significantly associated with other short-term adverse outcomes [39,44,50,43] .

[50]
The risk of stroke for patients with POAF is higher when compared to patients who remain in sinus rhythm (8.5% vs. 0.0%) . POAF has also been associated
[32]
with a longer and more tenuous length of stay than no postoperative AF (9 days vs. 6 days; P < 0.01) . This same outcome has been seen by other