Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation

Ad, Niv; Holmes, Sari D.; Massimiano, Paul S.; Rongione, Anthony J.; Fornaresio, Lisa M.

doi:10.1016/j.jtcvs.2017.09.147

Cited by 81 publications

(54 citation statements)

References 28 publications

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“…The answer is yes. Ad and colleagues 1 report very low morbidity and mortality among the 473 patients in this series who underwent combined ablation and mitral valve surgery. 2.…”

Section: Is Ablation Safe?mentioning

confidence: 67%

Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity

Gillinov

Soltesz

2018

The Journal of Thoracic and Cardiovascular Surgery

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Atrial fibrillation (AF) is present in 25% to 50% of patients seen for mitral valve surgery. Although it is likely that earlier referral of patients for mitral valve surgery will reduce this percentage, it is certain that surgeons will continue to see patients who have AF for mitral surgery. But will they treat them completely and correctly? Specifically, will they address the AF? With the left atrium opened to visualize the mitral valve, the surgeon has a once-in-alifetime opportunity to perform an ablation. In this issue of the Journal, Ad and colleagues 1 report their extensive experience and long-term results with surgical ablation in patients undergoing mitral valve surgery. In their introduction, they point out (1) that AF is associated with excess morbidity and reduced survival and (2) that surgical ablation of AF remains underused, with many surgeons simply choosing to ignore the AF at the time of mitral valve surgery. The results of this excellent series performed by experts in the field should encourage surgeons to do the right thing: ablate AF when performing mitral valve surgery. RESULTS OF ABLATION When considering the results of surgical ablation, 3 important questions come to mind, and Ad and colleagues 1 answer all of them.

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“…The answer is yes. Ad and colleagues 1 report very low morbidity and mortality among the 473 patients in this series who underwent combined ablation and mitral valve surgery. 2.…”

Section: Is Ablation Safe?mentioning

confidence: 67%

Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity

Gillinov

Soltesz

2018

The Journal of Thoracic and Cardiovascular Surgery

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“…Caswell et al [3] demonstrated that postoperative AF was a risk factor of cardioembolic stroke after valve replacement, and restoration of sinus rhythm is considered to be bene cial for improving long-term outcomes [4]. Surgery for AF has been shown to be feasible and effective, and does not increase perioperative morbidity and mortality when combined with other cardiac procedures [5] [6] [7]. While effective, the Coxmaze III procedure has limitations for the treatment of AF, as it is both invasive and time consuming.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Lin

Luo

et al. 2020

Preprint

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Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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“…Caswell et al [ 3 ] demonstrated that postoperative AF was a risk factor of cardioembolic stroke after valve replacement, and restoration of sinus rhythm is considered to be beneficial for improving long-term outcomes [ 4 ]. Surgery for AF has been shown to be feasible and effective, and does not increase perioperative morbidity and mortality when combined with other cardiac procedures [ 5 – 7 ]. While effective, the Cox-maze III procedure has limitations for the treatment of AF, as it is both invasive and time consuming.…”

Section: Introductionmentioning

confidence: 99%

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: a comparative study with propensity score matching from a single-Centre

Lin

Luo

et al. 2020

J Cardiothorac Surg

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Abstracts Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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Long-term outcome following concomitant mitral valve surgery and Cox maze procedure for atrial fibrillation

Cited by 81 publications

References 28 publications

Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity

Atrial fibrillation in the patient undergoing mitral valve surgery: A once-in-a-lifetime opportunity

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: a comparative study with propensity score matching from a single-Centre

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