Surgical Ablation for Atrial Fibrillation During Minimally Invasive Mitral Valve Surgery: Risk Dependencies and Long-Term Survival

Objective: Atrial fibrillation (AF) is a common finding among patients with mitral valve disease, with a growing body of evidence showing survival benefits associated with surgical ablation (SA). However, a lack of data persists regarding the safety and survival after SA concomitant to minimally invasive mitral valve surgery (MIMVS). Methods: We retrospectively collected data from the Polish National Registry of Cardiac Surgery Procedures (Krajowy Rejestr Operacji Kardiochirurgicznych), searching for all adult patients with AF who underwent MIMVS between 2006 and 2021. Initially, 1,545 patients were identified; SA was performed on 512 patients (33.2%). Propensity score matching comparing MIMVS + SA versus MIMVS alone was performed. Results: Matching resulted in 365 pairs with similar baseline characteristics (median age = 65 years, interquartile range [IQR]: 58 to 70 years; median EuroSCORE II = 2.2%, IQR: 1.4 to 3.4). We observed no differences in 24 h mortality for MIMVS + SA versus MIMVS alone (0.3% vs 0.0%, P = 0.99). Although there was no difference in in-hospital complications, neurologic complications were reported less frequently in the SA group (2.7% vs 8.2%, P = 0.002). Unadjusted survival analysis favored MIMVS+SA (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.40 to 0.69, P < 0.001). However, after adjustment for baseline risk factors, the effect was no longer significant (HR = 0.85, 95% CI: 0.56 to 1.32, P = 0.48). When stratified on baseline CHA 2 DS 2 -VASc score, a gradient of benefit was seen, with patients at higher thromboembolic risk gaining the most benefits from concomitant SA. Conclusions: Patients with a higher thromboembolic risk gain the most benefits from concomitant SA. SA was associated with fewer neurologic complications.

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Journal
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery
Published
2026-09-07
DOI
https://doi.org/10.1177/15569845261472462
Primary Topic
Atrial Fibrillation Management and Outcomes
Type
article
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article

Surgical Ablation for Atrial Fibrillation During Minimally Invasive Mitral Valve Surgery: Risk Dependencies and Long-Term Survival

Marek Deja, Bohdan Maruszewski, Piotr Suwalski, Emil Julian Dąbrowski et al.
Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery
Atrial Fibrillation Management and Outcomes
article

Surgical Ablation for Atrial Fibrillation During Minimally Invasive Mitral Valve Surgery: Risk Dependencies and Long-Term Survival

Marek Deja, Bohdan Maruszewski, Piotr Suwalski, Emil Julian Dąbrowski, Michele Pilato, Tomasz Hirnle, Radosław Litwinowicz, Mariusz Kowalewski, Calogera Pisano, Jakub Batko, Michał Święczkowski, Krzysztof Bartuś, Karol Gostomczyk, Giuseppe Maria Raffa, Tomasz Urbanowicz, Marek Jasinski, Kazimierz Widenka, Łukasz Kuźma, Wojciech Wańha, Roberto Lorusso, Wojciech Wojakowski, Francesco Musumeci, Fabrizio D’Ascenzo, Zdzisław Tobota
article en

Abstract

Objective: Atrial fibrillation (AF) is a common finding among patients with mitral valve disease, with a growing body of evidence showing survival benefits associated with surgical ablation (SA). However, a lack of data persists regarding the safety and survival after SA concomitant to minimally invasive mitral valve surgery (MIMVS). Methods: We retrospectively collected data from the Polish National Registry of Cardiac Surgery Procedures (Krajowy Rejestr Operacji Kardiochirurgicznych), searching for all adult patients with AF who underwent MIMVS between 2006 and 2021. Initially, 1,545 patients were identified; SA was performed on 512 patients (33.2%). Propensity score matching comparing MIMVS + SA versus MIMVS alone was performed. Results: Matching resulted in 365 pairs with similar baseline characteristics (median age = 65 years, interquartile range [IQR]: 58 to 70 years; median EuroSCORE II = 2.2%, IQR: 1.4 to 3.4). We observed no differences in 24 h mortality for MIMVS + SA versus MIMVS alone (0.3% vs 0.0%, P = 0.99). Although there was no difference in in-hospital complications, neurologic complications were reported less frequently in the SA group (2.7% vs 8.2%, P = 0.002). Unadjusted survival analysis favored MIMVS+SA (hazard ratio [HR] = 0.52, 95% confidence interval [CI]: 0.40 to 0.69, P < 0.001). However, after adjustment for baseline risk factors, the effect was no longer significant (HR = 0.85, 95% CI: 0.56 to 1.32, P = 0.48). When stratified on baseline CHA 2 DS 2 -VASc score, a gradient of benefit was seen, with patients at higher thromboembolic risk gaining the most benefits from concomitant SA. Conclusions: Patients with a higher thromboembolic risk gain the most benefits from concomitant SA. SA was associated with fewer neurologic complications.

Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery
Poznan University of Medical Sciences (PL), Jagiellonian University (PL), Bydgoszcz University of Science and Technology (PL), Medical University of Białystok (PL), Medical University of Silesia (PL), Maastricht University Medical Centre (NL), Nicolaus Copernicus University (PL), Wroclaw Medical University (PL), Azienda Ospedaliera Citta' della Salute e della Scienza di Torino (IT), Children's Memorial Health Institute (PL), Precision for Medicine (United States) (US), Ministry of Interior and Administration (PL), Silesian Center for Heart Disease (PL), Institute of Cardiology (PL), Foundation of Cardiac Surgery Development (PL), Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione (IT), University of Turin (IT), AGH University of Krakow (PL), University of Rzeszów (PL)
Good health and well-being
Openalex Percentile: Top 10%
Atrial Fibrillation Management and Outcomes
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