학술논문
Survival after surgical ablation for atrial fibrillation in mitral valve surgery: Analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK)
Document Type
Report
Author
Suwalski, Piotr; Kowalewski, Mariusz; Jasinski, Marek; Staromlynski, Jakub; Zembala, Marian; Widenka, Kazimierz; Brykczynski, Miroslaw; Skiba, Jacek; Zembala, Michal Oskar; Bartus, Krzysztof; Hirnle, Tomasz; Dziembowska, Inga; Tobota, Zdzislaw; Maruszewski, Bohdan J.; Anisimowicz, Lech; Biederman, Andrzej; Borkowski, Dariusz; Bugajski, Pawel; Cholewinski, Pawel; Cichon, Romuald; Cisowski, Marek; Deja, Marek; Dziatkowiak, Antoni; Gburek, Tadeusz; Gryczko, Leszek; Haponiuk, Ireneusz; Hendzel, Piotr; Jablonka, Stanislaw; Jarmoszewicz, Krzysztof; Jasinski, Jaroslaw; Jaszewski, Ryszard; Jemielity, Marek; Kalawski, Ryszard; Kapelak, Boguslaw; Kaperczak, Jacek; Karolczak, Maciej A.; Krejca, Michal; Kustrzycki, Wojciech; Kusmierczyk, Mariusz; Kwinecki, Pawel; Missima, Maurycy; Moll, Jacek J.; Ogorzeja, Wojciech; Pajak, Jacek; Pawliszak, Wojciech; Pietrzyk, Edward; Religa, Grzegorz; Rogowski, Jan; Rozanski, Jacek; Sadowski, Jerzy; Sharma, Girish; Skalski, Janusz; Stanislawski, Ryszard; Stazka, Janusz; Stepinski, Piotr; Suwalski, Kazimierz; Tulecki, Lukasz; Wojtalik, Michal; Wos, Stanislaw; Zelazny, Piotr
Source
Journal of Thoracic and Cardiovascular Surgery. March 2019, Vol. 157 Issue 3, 1007
Subject
Language
English
ISSN
0022-5223
Abstract
Key Words mitral valve; registry; surgical ablation; long-term results; atrial fibrillation Abstract Objectives 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. Methods 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 [plus or minus] 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. Results Of included patients, 2449 (21.5%) underwent surgical ablation for AF. Patients in this group were significantly younger (63.8 [plus or minus] 8.7 years vs 66.1 [plus or minus] 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. Conclusions Concomitant surgical ablation for AF in patients undergoing mitral valve procedures is safe, feasible, and significantly improves late survival. Abbreviations and Acronyms AF, atrial fibrillation; CAD, coronary artery disease; EuroSCORE, European system for cardiac operative risk evaluation; HLoS, hospital length of stay; IABP, intra-aortic balloon pump; ICU, intensive care unit; KROK, Krajowy Rejestr Operacji Kardiochirurgicznych (Polish National Registry of Cardiac Surgery Procedures); LVEF, left ventricle ejection fraction; MI, myocardial infarction; MV, mitral valve; STS, Society of Thoracic Surgeons