Trend and early clinical outcomes in patients with preexisting atrial fibrillation undergoing isolated mitral valve surgery with or without surgical ablation

TL;DR

This study examines the clinical outcomes of patients with atrial fibrillation undergoing mitral valve surgery with or without surgical ablation in the UK.

Contribution

The study provides new insights into the short-term outcomes of surgical ablation in patients with preexisting atrial fibrillation undergoing mitral valve surgery.

Findings

Surgical ablation was associated with longer cardiopulmonary bypass and aortic cross-clamp times.

There was no significant difference in in-hospital mortality or other major post-operative complications between groups.

Abstract

European and American guidelines recommend concomitant surgical ablation for atrial fibrillation (AF) in patients undergoing mitral valve surgery. There is evidence that this intervention reduces the incidence of early and mid-term incidence of AF post-operatively. We aim to report the trend and early clinical outcomes in this cohort of patients in the United Kingdom.

This study included all patients with underlying atrial fibrillation who underwent first-time, elective, or urgent isolated mitral valve repair/replacement from 2011 to April 2019. We evaluated the trend and early clinical outcomes between patients who did/did not receive surgical AF ablation and examined associated factors.

A total of 3497 patients were included, with a median age of 70.6 years old (IQR: 63.1, 76.5), and 52.67% were male. The number of isolated mitral valve surgery performed ranges between 388 to 464 during the study period. The mitral valve repair rate was 62%. The overall AF ablation rate was 27.71% (Range: 16.74%-33.33%). After inverse propensity score matching, patients who underwent AF ablation had a significantly longer cardiopulmonary bypass (125 vs 99 mins, p < .001) and aortic cross-clamp time (92 vs 73 mins, p < .001). However, there was no difference in in-hospital mortality (2.03% vs 1.80%, p = .69), return to theatre for bleeding (5.82% vs 7.44%, p = .11), post-operative stroke (0.61% vs 0.48%, p = .11), post-operative dialysis (2.54% vs 2.40%, p = .83) and deep sternal wound infection (0.56% vs 0.88%, p = .34).

Patients with pre-existing atrial fibrillation undergoing concomitant surgical ablation during mitral valve intervention had a longer cardiopulmonary bypass and cross-clamp time without compromising short-term clinical outcomes. Long-term outcomes are required to examine the potential lasting benefit of surgical ablation.

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