Perioperative and mid-term outcomes of mitral valve surgery with and without concomitant surgical ablation for atrial fibrillation: a retrospective analysis.

Pregaldini, Fabio; Celik, Mevlüt; Mosbahi, Selim; Barmettler, Stefania; Praz, Fabien; Reineke, David; Siepe, Matthias; Pingpoh, Clarence (2024). Perioperative and mid-term outcomes of mitral valve surgery with and without concomitant surgical ablation for atrial fibrillation: a retrospective analysis. Interdisciplinary cardiovascular and thoracic surgery, 39(2) Oxford University Press 10.1093/icvts/ivae144

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OBJECTIVES

We retrospectively analyzed perioperative and mid-term outcome for patients undergoing mitral valve surgery with and without atrial fibrillation.

METHODS

Patients who underwent mitral valve surgery between January 2018 and February 2023 were included and categorized into three groups: "No AF" (no documented atrial fibrillation), "AF no SA" (atrial fibrillation without surgical ablation), and "AF and SA" (atrial fibrillation with concomitant surgical ablation). Groups were compared for perioperative and mid-term outcomes, including mortality, stroke, bleeding and pacemaker implantation. A p-value < 0.05 was considered statistically significant.

RESULTS

Of the 400 patients included, preoperative atrial fibrillation was present in 43%. Mean follow-up was 1.8 (SD: 1.1) years. The patients who underwent surgical ablation for atrial fibrillation exhibited similar overall outcomes compared to patients without preoperative atrial fibrillation. Patients with untreated atrial fibrillation showed higher mortality ("No AF": 2.2% vs "AF no SA": 8.3% vs "AF and SA": 3.2%; p-value 0.027) and increased postoperative pacemaker implantation rates ("No AF": 5.7% vs "AF no SA": 15.6% vs "AF and SA": 7.9%, p-value: 0.011). In a composite analysis of adverse events (Mortality, Bleeding, Stroke), the highest incidence was observed in patients with untreated atrial fibrillation, while patients with treated atrial fibrillation had similar outcomes as those without preoperative documented atrial fibrillation ("No AF": 9.6% vs "AF no SA": 20.2% vs "AF and SA" 3: 9.5%, p-value: 0.018).

CONCLUSIONS

Concomitant surgical ablation should be considered in mitral valve surgery for atrial fibrillation, as it leads to similar mid-term outcomes compared to patients without preoperative documented atrial fibrillation.

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