Mitral valve surgery plus concomitant atrial fibrillation ablation is superior to mitral valve surgery alone with an intensive rhythm control strategy☆☆☆

Oppell, Ulrich O. von; Masani, Navroz; O’Callaghan, Peter; Wheeler, Richard; Dimitrakakis, Georgios; Schiffelers, Sandra

doi:10.1016/j.ejcts.2008.12.042

Cited by 92 publications

(81 citation statements)

References 23 publications

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“…von Oppell et al [17] randomized 50 patients for mitral valve surgery with or without concomitant AF ablation. Those who remained in sinus rhythm had better scores on quality of life questionnaires and were more in free use of anticoagulants and antiarrhythmics.…”

Section: Discussionmentioning

confidence: 99%

Tratamento cirúrgico de fibrilação atrial utilizando ablação com radiofrequência bipolar em doença mitral reumática

Canale¹,

Colafranceschi²,

Monteiro³

et al. 2011

Rev Bras Cir Cardiovasc

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Objective: To analyze the effectiveness of surgical treatment of atrial fibrillation (AF) using bipolar radiofrequency ablation during mitral valve procedures of rheumatic etiology in heart surgery.Methods: We retrospectively reviewed medical registries of 53 patients submitted to atrial ablation with bipolar radiofrequency energy during mitral valve surgery. Thirty four (64%) patients were women and the age varied from 27 to 72 years old (average: 49.3 ± 10.7 years). Aortic and/or tricuspid procedures were also present in 36 (68%) patients. Average time of reported atrial fibrillation was 41 months (from 3 to 192 months). Type of AF was classified as: paroxysmal in 8 patients, persistent in 3, permanent in 42. Left atrium had an average size of 52.9 ± 8.5 mm. The surgeries in these series were: 47 mitral valve replacements and 6 mitral valve repairs. Eletrocardiografic follow up was 83% complete in 14 months. Data from 24h Holter were explored.Results: Seven (13%) perioperative deaths were observed and survival after 14 months was 87%. Observed heart rhythm after 1 year of surgery was sinus rhythm in 25 (66%) patients, AF in 7 (18%), flutter in 7 (13%), junctional in 1 (3%).Conclusion: Bipolar radiofrequency ablation in patients submitted to mitral valve surgery of rheumatic etiology is effective in converting to sinus rhythm in 68% of patients after 14 months. Descriptors

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Section: Discussionmentioning

confidence: 99%

Tratamento cirúrgico de fibrilação atrial utilizando ablação com radiofrequência bipolar em doença mitral reumática

Canale¹,

Colafranceschi²,

Monteiro³

et al. 2011

Rev Bras Cir Cardiovasc

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“…Patients were assessed at 6 months after their surgeries for a number of clinical parameters in addition to physical functioning, general health, vitality, and social functioning. 23 Scores on all these domains increased significantly after surgery for all patients and did not differ between treatment groups. 23 In contrast to most of these studies, in the present study, we specifically assessed HRQL in a larger sample size at 6 months and 1 year after surgery.…”

Section: Advantages Of Minimally Invasive Cardiac Proceduresmentioning

confidence: 89%

“…23 Scores on all these domains increased significantly after surgery for all patients and did not differ between treatment groups. 23 In contrast to most of these studies, in the present study, we specifically assessed HRQL in a larger sample size at 6 months and 1 year after surgery. Our results make a unique contribution to this area of research by directly measuring patient-reported HRQL after minimally invasive surgery with a validated and widely used psychometric instrument and identifying some of the factors that influence its improvement in relation to baseline values.…”

Section: Advantages Of Minimally Invasive Cardiac Proceduresmentioning

confidence: 89%

Health-Related Quality of Life after Minimally Invasive Cardiac Surgery

Holmes

Fornaresio

Shuman

et al. 2016

Innovations�(Phila)

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Objective Factors influencing health-related quality of life (HRQL) after minimally invasive cardiac surgery have not been well described. We examined the trajectory of HRQL after minimally invasive cardiac surgery and the role of perioperative factors and rhythm on HRQL changes. Methods Patients underwent minimally invasive surgical ablation for atrial fibrillation and/or valve surgery (n = 235). Health-related quality of life (SF-12) and clinical status were assessed preoperatively and postoperatively. Results Physical summary HRQL (F = 36.2, P < 0.001) and mental summary HRQL (F = 3.2, P = 0.047) improved significantly by 12 months after surgery. Improvement on HRQL peaked at 6 months and plateaued between 6 and 12 months. Physical HRQL was similar to age-based normal values before surgery (P = 0.66) and surpassed norms by 6 months after surgery (P < 0.001). Younger age (r = −0.15, P = 0.02) and lower EuroSCORE II (r = −0.19, P = 0.003) correlated with greater HRQL improvements by 6 months. Only lower EuroSCORE II (r = −0.14, P = 0.04) correlated with greater HRQL improvement by 12 months. Length of stay and major morbidity were not related to HRQL improvement. In surgical ablation patients, restoration of stable sinus rhythm throughout the first 12 months was associated with greater physical HRQL improvement by 6 months compared with patients who had atrial arrhythmia recurrences (change, 5.0 vs. −1.0, P = 0.02). Conclusions Health-related quality of life improved significantly after minimally invasive cardiac surgery. These improvements were influenced by age, operative risk, symptoms, and rhythm status. Even patients with HRQL in a normal range before surgery can experience improved HRQL after surgery. Minimally invasive cardiac surgery can offer decreased postoperative complications and also improved HRQL.

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“…Several observational studies strongly suggests that surgical intervention is beneficial for return to sinus rhythm (54,56,57). The original Maze III cohort reported by Dr. Cox's group showed 95.9% and 97.5% freedom from AF at 5.4 years performed in lone and concomitant AF, respectfully (54).…”

Section: Sinus Restorationmentioning

confidence: 99%