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Dokko et al. Vessel Plus 2022;6:53 Vessel Plus
DOI: 10.20517/2574-1209.2022.11

Original Article Open Access

Predictors and risk-adjusted outcomes of new-onset

postoperative atrial fibrillation in repeat surgical and
valve-in-valve transcatheter aortic valve replacement

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Julia Dokko , Samantha Novotny , Natalie Kolba , Sohaib Agha , Ashutosh Yaligar , Vineet Tummala , Puja
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2,#
B. Parikh , Aurora D. Pryor , Henry J. Tannous , A. Laurie Shroyer , Thomas Bilfinger 2,#
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Renaissance School of Medicine, Undergraduate Medical Education, Stony Brook University, Stony Brook, NY 11794-8343, USA.
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Department of Surgery, Renaissance School of Medicine, Stony Brook, NY 11794-8191, USA.
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Department of Medicine, Renaissance School of Medicine, Stony Brook, NY 11794-8167, USA.
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A. Laurie Shroyer and Thomas Bilfinger are listed as co-senior authors.
Correspondence to: Prof. A. Laurie Shroyer, Department of Surgery, Stony Brook Renaissance School of Medicine, MART level 8,
room 08-014, 100 Nicolls Road, Stony Brook, NY 11794-8191, USA. E-mail: AnnieLaurie.Shroyer@stonybrookmedicine.edu
How to cite this article: Dokko J, Novotny S, Kolba N, Agha S, Yaligar A, Tummala V, Parikh PB, Pryor AD, Tannous HJ, Shroyer
AL, Bilfinger T. Predictors and risk-adjusted outcomes of new-onset postoperative atrial fibrillation in repeat surgical and valve-
in-valve transcatheter aortic valve replacement. Vessel Plus 2022;6:53. https://dx.doi.org/10.20517/2574-1209.2022.11
Received: 28 Feb 2022 First Decision: 6 May 2022 Revised: 4 Jun 2022 Accepted: 11 Jul 2022 Published: 10 Oct 2022
Academic Editor: Frank W. Sellke Copy Editor: Haixia Wang Production Editor: Haixia Wang
Abstract
Aim: New-onset postoperative atrial fibrillation/flutter (POAF/AFL) complications have not been well studied for
repeat aortic valve replacements (r-AVR); this study identified risk factors predisposing to POAF/AFL and
POAF/AFL’s effect upon risk-adjusted outcomes.

Methods: Using New York State’s Statewide Planning and Research Cooperative System records (2005-2018),
multivariable forward selection models identified risks predictive of POAF/AFL. To identify POAF/AFL’s impact
upon risk-adjusted mortality/morbidity (MM) and 30-day readmission (READMIT), forward selection logistic
regression models applied Firth bias correction to address data sparsity.

Results: Of the 242 r-AVR patients, 147 underwent repeat surgical aortic valve replacements (r-SAVR) and 95
underwent valve-in-valve transcatheter aortic valve replacements (ViV-TAVR); 39.46% of r-SAVR and 43.16% of
ViV-TAVR patients had POAF/AFL. R-SAVR patients with POAF/AFL were older (69.7 ± 11.1 vs. 56.7 ± 13.2 years,
P < 0.01) compared to R-SAVR patients without POAF/AFL. Multivariable models identified an enhanced
POAF/AFL risk for elderly (OR: 1.05, 95%CI: 1.03-1.07, P < 0.01) and cerebral vascular disease (OR: 2.18, 95%CI:
1.05-4.55, P = 0.04) patients.

© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0
International License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, sharing,
adaptation, distribution and reproduction in any medium or format, for any purpose, even commercially, as
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