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Page 10 of 15 Dokko et al. Vessel Plus 2022;6:53 https://dx.doi.org/10.20517/2574-1209.2022.11

did not differ between ViV-TAVR patients with and without POAF/AFL.

Multivariate predictors of POAF/AFL
Multivariable regression analysis of predictors of POAF/AFL are shown in [Table 4]. Older age (OR: 1.05,
95%CI: 1.03-1.07, P < 0.01) and patients with cerebral vascular disease (OR: 2.18, 95%CI: 1.05-4.55, P = 0.04)
were significant predictors of POAF/AFL. The c-index of this model was 0.686 and the Hosmer and
Lemeshow Goodness-of-Fit Test p-value was 0.07 (i.e., indicating acceptable calibration).

Outcomes of r-SAVR and ViV-TAVR patients with POAF/AFL
The outcomes of r-AVR patients were analyzed and listed by surgery type and POAF/AFL in [Table 3].
Patients who underwent r-SAVR with POAF/AFL, compared to r-SAVR patients without POAF/AFL, were
more likely to result in READMIT (22.4% vs. 9.0%, P = 0.02), prolonged ventilation (12.1% vs. 1.1%,
P = 0.01), cardiac arrest (17.2% vs. 3.4%, P = 0.01), and longer length of stay (mean ± SD: 13.4 ± 11.8 vs.
9.2 ± 7.3 days, P = 0.02) compared to r-SAVR patients without POAF/AFL. Compared to ViV-TAVR
patients with no-POAF/AFL, longer length of stay occurred for ViV-TAVR patients with POAF/AFL
(12.5 + 10.7 vs. 6.8 + 7.6, P = 0.01). Comparing r-SAVR patients with and without POAF/AFL and ViV-
TAVR patients with and without POAF/AFL, however, there was no difference in the MM composite (P =
0.37 and 0.39, respectively).

Multivariate predictors of MM and READMIT
For either r-SAVR or ViV-TAVR, the results of the multivariable regression model for MM were reported
in [Table 5]. POAF/AFL was not a significant predictor of MM (P = 0.55). With multivariable associations
documented (i.e., P < 0.05), however, the variables black race (OR: 4.97, 95%CI: 1.61-15.37, P < 0.01) and
Elixhauser score (OR: 1.05, 95%CI: 1.02-1.08, P < 0.01) were associated with increased MM. The c-index of
the MM predictive model was 0.713 with the Hosmer and Lemeshow Goodness-of-Fit Test P = 0.85.

As an important resource consumption metric, POAF/AFL (OR: 3.12, 95%CI: 1.46-6.65, P < 0.01) was
shown to be a significant predictor of READMIT as shown in [Table 6]. The c-index of this READMIT
model was 0.638. Due to the limited number of READMIT final multivariable models’ degrees of freedom,
it was not possible to calculate a Hosmer and Lemeshow Goodness-of-Fit test statistic.

DISCUSSION
As a novel contribution to the r-AVR literature, this retrospective observational cohort study documented
the impact of POAF/AFL upon clinical outcomes and resource utilization. With an overall POAF/AFL
incidence of 41%, this was by far the most common complication found following r-AVR procedures. As
noted in the prior literature, older age and cerebral vascular disease were predictors of r-AVR
POAF/AFL [16,22-26] . Holding other risk factors constant, POAF/AFL was a predictor of READMIT, but not
predictive of MM. Importantly, however, black patients and Elixhauser score were predictors of MM; thus,
these “at risk” r-AVR patients deserve future investigation.

The 41% incidence of POAF/AFL in New York State’s SPARCS is consistent with Ejiofor et al.’s study which
reported nearly the same rate when comparing postoperative complications between patients who
underwent r-SAVR and ViV-TAVR in a matched cohort study . In our study, the incidence of POAF/AFL
[19]
was not significantly different between r-AVR procedure types; in part, this may be due to the difference in
baseline characteristics between patients who underwent r-SAVR and ViV-TAVR.