1. Survival after surgical ablation for atrial fibrillation in mitral valve surgery : analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK)
- Author
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Tomasz Hirnle, Jacek Pająk, Ryszard Jaszewski, Leszek Gryczko, Michał Wojtalik, Piotr Hendzel, Jerzy Sadowski, Paweł Bugajski, Janusz Stążka, Kazimierz Suwalski, Ryszard Stanisławski, Zdzislaw Tobota, Marian Zembala, Dariusz Borkowski, Krzysztof Jarmoszewicz, Maurycy Missima, Lech Anisimowicz, Maciej A. Karolczak, Stanisław Jabłonka, Romuald Cichon, Paweł Cholewiński, Mariusz Kowalewski, Janusz Skalski, Marek Jemielity, Bogusław Kapelak, Edward Pietrzyk, Mirosław Brykczyński, Wojciech Ogorzeja, Jan Rogowski, Bohdan Maruszewski, Wojciech Kustrzycki, Jacek Kaperczak, Piotr Stępiński, Piotr Żelazny, Ryszard Kalawski, Marek A. Deja, Michał Krejca, Marek Jasinski, Krzysztof Bartuś, Jacek Skiba, Łukasz Tułecki, Jacek Różański, Piotr Suwalski, Stanisław Woś, Jakub Staromłyński, Jacek J. Moll, Grzegorz Religa, Tadeusz Gburek, Wojciech Pawliszak, Mariusz Kuśmierczyk, Michał Zembala, Andrzej Biederman, Jarosław Jasiński, Inga Dziembowska, Paweł Kwinecki, Ireneusz Haponiuk, Kazimierz Widenka, Girish Sharma, Marek Cisowski, and Antoni Dziatkowiak
- Subjects
Pulmonary and Respiratory Medicine ,medicine.medical_specialty ,Ejection fraction ,Proportional hazards model ,business.industry ,medicine.medical_treatment ,Atrial fibrillation ,EuroSCORE ,030204 cardiovascular system & hematology ,medicine.disease ,Surgery ,Coronary artery disease ,03 medical and health sciences ,0302 clinical medicine ,medicine.anatomical_structure ,030228 respiratory system ,Interquartile range ,Mitral valve ,medicine ,Cardiology and Cardiovascular Medicine ,business ,Intra-aortic balloon pump - Abstract
Surgical ablation for atrial fibrillation (AF) performed at the time of other valvular- or nonvalvular cardiac procedure is a mainstay of therapy; yet the data regarding its influence on remote survival are sparse. We aimed to evaluate late survival in patients undergoing mitral valve (MV) surgery with concomitant surgical ablation for AF.Procedure-related data from the Polish National Registry of Cardiac Surgery Procedures (Krajowy Rejestr Operacji Kardiochirurgicznych) were retrospectively collected. A total of 11,381 patients with baseline AF (46.6% men; mean age 65.6 ± 9.0 years) undergoing MV surgery between 2006 and 2017 in 37 reference centers across Poland and included in the registry were analyzed. Median follow-up was 5 years (mean, 4.6 years; interquartile range, 1.9-7.9 years). Cox proportional hazards models were used for computations. Propensity score matching for the comparison of MV + ablation versus MV alone was performed.Of included patients, 2449 (21.5%) underwent surgical ablation for AF. Patients in this group were significantly younger (63.8 ± 8.7 years vs 66.1 ± 9.0 years; P .001) and were at lower baseline surgical risk (EuroSCORE, 2.86 vs 3.69; P .001). During the 12-year study period, there was a significant survival benefit (hazard ratio, 0.71; 95% confidence interval, 0.63-0.79; P .001) for MV + ablation compared with MV alone. After rigorous propensity matching (logit model, 1784 pairs) surgical ablation was associated with nearly 20% improved survival (hazard ratio, 0.82; 95% confidence interval, 0.70-0.96; P = .011). Benefit of surgical ablation was maintained in subgroup analyses, yet most benefit was appraised in low-risk patients such as those with EuroSCORE of 2 to 5 or age 50 years.Concomitant surgical ablation for AF in patients undergoing mitral valve procedures is safe, feasible, and significantly improves late survival.
- Published
- 2019