Let us discuss postoperative complications after open heart surgery and after minimally invasive transcatheter heart valve treatment procedures. One of the common complications is atrial fibrillation, but it's not the only one. How to treat postoperative atrial fibrillation? What is the prognosis in postoperative atrial fibrillation after heart surgery?
Atrial fibrillation is one of the possible complications. It is, I must say, quite common after open-heart surgery. Usually, the patient responds very fast to the treatment with amiodarone. The situation can be very well controlled. The patient will have a long-term prognosis which is absolutely normal. If atrial fibrillation persists after the surgical treatment of some heart disease, then then the impact on prognosis is not negligible. It is so because atrial fibrillation has a negative impact on survival and the quality of life. A patient has to have oral anticoagulation. Certainly, also the style of life is totally different. But this is true if atrial fibrillation was not present before the surgical operation. It is very difficult if the atrial fibrillation has been present in the long term. If atrial fibrillation is only temporary, those cases can be very easily treated with antiarrhythmic medications.
What do you consider a period during which you would say to a patient? Okay, your postoperative atrial fibrillation is transient. Let's give it another month or two months.
Usually, atrial fibrillation occurs after surgery in the first few days, in the first week. If a heart valve operation has been successful, rarely, atrial fibrillation occurs later on. So temporary atrial fibrillation is typical of the first week after cardiac surgery.
How long does usually atrial fibrillation last after surgical operation?
The patient is still hospitalized in this case, and atrial fibrillation is treated immediately and almost invariably with a very good result. Atrial fibrillation treatment is usually an infusion of amiodarone. If this is not effective, electroshock can be used.
So if it goes on for a month or two months, that's already considered chronic atrial fibrillation?
This is very uncommon, but if atrial fibrillation was not present before the surgical operation, it's very uncommon that atrial fibrillation is present postoperatively. It is very uncommon that atrial fibrillation lasts a long time.
Then you consider the ablation of the arrhythmogenic foci?
You can consider ablation of arrhythmogenic foci and treat atrial fibrillation when it becomes chronic.
What are the other common complications postoperatively in heart valve surgery?
One of the most common complications can be different degrees of low cardiac output. Low cardiac output is quite common, particularly if the operation is carried out not in the very early stage of heart disease. Heart valve problems can be present for a long time. There was ventricular dysfunction before the surgical operation. Then you can have a low cardiac output postoperatively. Low cardiac output is treated first with the medication. Then you can use intraaortic balloon counterpulsation. You can even use ECMO, which supplies the heart and the lungs for a while [with artificially oxygenated blood]. Low cardiac output can be treated. Sometimes low cardiac output can be so severe. It can also be fatal. Fortunately, it is very, very rare nowadays. Then you can have other complications like renal dysfunction. You can also have pulmonary problems. And this is very catastrophic bu tit is very, very rare. You can have a brain injury after cardiac surgery. That is really something that is a tragedy. It occurs very, very rare today, but it's something that can happen.