Study population
Between July 2008 and July 2018, 2,628 consecutive patients underwent first-time, elective isolated surgical AVR using a mechanical or stented biological valve prosthesis. Patients with concomitant cardiac surgeries, previous cardiac surgery, urgent/emergency surgeries, or transthoracic echocardiography showing other significant valve abnormalities apart from those concerning the aortic valve were excluded. Preoperative AF was documented on a 12-lead electrocardiogram and/or Holter recording within the 3 months prior to surgery. There was no distinction made between preoperative paroxysmal or persistent AF. Data on the duration of AF diagnosis were not available. The AVR was performed according to standard of care and in line with local protocols. In addition to patient’s preference, the cut-off age for using mechanical versus biological prosthesis was dictated according to updated practice guidelines.