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Thorac Cardiovasc Surg 2016; 64(05): 427-433
DOI: 10.1055/s-0035-1555753
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Subclinical Hypothyroidism Might Increase the Risk of Postoperative Atrial Fibrillation after Aortic Valve Replacement

Jose Martínez-Comendador
1   Department of Cardiac Surgery, Hospital of Leon, Leon, Spain
,
Jose Miguel Marcos-Vidal
2   Department of Anesthesiology, Hospital of Leon, Leon, Spain
,
Javier Gualis
1   Department of Cardiac Surgery, Hospital of Leon, Leon, Spain
,
Carlos Esteban Martin
1   Department of Cardiac Surgery, Hospital of Leon, Leon, Spain
,
Elio Martin
1   Department of Cardiac Surgery, Hospital of Leon, Leon, Spain
,
Javier Otero
1   Department of Cardiac Surgery, Hospital of Leon, Leon, Spain
,
Mario Castaño
1   Department of Cardiac Surgery, Hospital of Leon, Leon, Spain
› Author Affiliations
Further Information

Publication History

12 January 2015

26 April 2015

Publication Date:
29 June 2015 (online)

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Abstract

Background To evaluate the influence of subclinical hypothyroidism (SCH) on the development of postoperative atrial fibrillation (AF) in patients undergoing aortic valve replacement surgery with extracorporeal circulation.

Methods A prospective study in a tertiary hospital between July 2005 and December 2013 in which all patients undergoing aortic valve replacement with no other valve surgery were consecutively included. Patients who were in preoperative sinus rhythm were selected and they underwent thyroxine (T4) and thyroid-stimulating hormone determination in the month before surgery. Postoperative AF was defined as the development of AF during hospital admittance. Descriptive analysis and binary logistic regression were performed for the target variable.

Results A total of 467 patients were studied, with 35 cases of SCH. The incidence of postoperative AF was 57% in the group with SCH versus 30.3% (p = 0.001) in the group without hypothyroidism, without significant differences in other postoperative complications. In the logistic regression analysis, the independent predictors of postoperative AF were SCH, age, and aortic clamping time. SCH multiplies the odds ratio of postoperative AF by 3.14 (95% confidence interval: 1.24–7.96).

Conclusion SCH behaves like a risk factor for the development of postoperative AF in patients undergoing aortic valve replacement with extracorporeal circulation. Other studies are needed to determine whether preoperative T4 replacement therapy and/or more aggressive AF prophylaxis can prevent this complication in patients undergoing aortic valve replacement.

Keywords

outcomes - cardiopulmonary bypass - heart valve surgery - postoperative care
 

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