TY - JOUR
T1 - Associations Between Surgical Ablation and Operative Mortality After Mitral Valve Procedures
AU - Rankin, J. Scott
AU - Grau-Sepulveda, Maria V.
AU - Ad, Niv
AU - Damiano, Ralph J.
AU - Gillinov, A. Marc
AU - Brennan, J. Matthew
AU - McCarthy, Patrick M.
AU - Thourani, Vinod H.
AU - Jacobs, Jeffrey P.
AU - Shahian, David M.
AU - Badhwar, Vinay
N1 - Funding Information:
This research was funded by an unrestricted grant from AtriCure USA. The authors wish to thank Sari D. Holmes, PhD, for help with presentation of statistical concepts.
Publisher Copyright:
© 2018 The Society of Thoracic Surgeons
PY - 2018/6
Y1 - 2018/6
N2 - Background: Surgical ablation (SA) for atrial fibrillation (AF) concomitant to mitral valve repair/replacement (MVRR) improves longitudinal sinus rhythm. However, the risk of adding SA remains a clinical question. This study examined whether the addition of contemporary SA for AF has an impact on operative outcomes. Methods: The study cohort included 88,765 MVRR patients with or without SA, coronary artery bypass grafting (CABG), septal defect, and tricuspid repair in The Society of Thoracic Surgeons Database between 2011 and 2014. Group 1 did not have AF (No-AF) and did not receive SA (No-SA); group 2 had No-AF immediately preoperatively but received SA; group 3 had AF but No-SA; and group 4 had AF with SA. Groups 3 and 4 were stratified into paroxysmal versus nonparoxysmal AF. With the use of logistic regression, with group 1 as reference, risk-adjusted odds ratios (OR) for mortality were compared for SA performance, AF type, and SA technique. Results: Group 3 had higher age, New York Heart Association class, redo operations, and unadjusted mortality than group 4. Relative to group 1, group 3 had an OR for mortality of 1.15 (95% confidence interval: 1.04 to 1.27, p < 0.01). OR increments were similar for paroxysmal and nonparoxysmal AF. In group 4, concomitant SA was independently associated with lower AF-related relative risk (OR 1.08), to a level that was not different from group 1 (p = 0.13). Observed treatment effects were equivalent for paroxysmal and nonparoxysmal AF and across all levels of baseline risk. Conclusions: For patients with AF at the time of mitral operation, the performance of SA seems associated with a lower risk-adjusted operative mortality compared with patients who do not undergo ablation.
AB - Background: Surgical ablation (SA) for atrial fibrillation (AF) concomitant to mitral valve repair/replacement (MVRR) improves longitudinal sinus rhythm. However, the risk of adding SA remains a clinical question. This study examined whether the addition of contemporary SA for AF has an impact on operative outcomes. Methods: The study cohort included 88,765 MVRR patients with or without SA, coronary artery bypass grafting (CABG), septal defect, and tricuspid repair in The Society of Thoracic Surgeons Database between 2011 and 2014. Group 1 did not have AF (No-AF) and did not receive SA (No-SA); group 2 had No-AF immediately preoperatively but received SA; group 3 had AF but No-SA; and group 4 had AF with SA. Groups 3 and 4 were stratified into paroxysmal versus nonparoxysmal AF. With the use of logistic regression, with group 1 as reference, risk-adjusted odds ratios (OR) for mortality were compared for SA performance, AF type, and SA technique. Results: Group 3 had higher age, New York Heart Association class, redo operations, and unadjusted mortality than group 4. Relative to group 1, group 3 had an OR for mortality of 1.15 (95% confidence interval: 1.04 to 1.27, p < 0.01). OR increments were similar for paroxysmal and nonparoxysmal AF. In group 4, concomitant SA was independently associated with lower AF-related relative risk (OR 1.08), to a level that was not different from group 1 (p = 0.13). Observed treatment effects were equivalent for paroxysmal and nonparoxysmal AF and across all levels of baseline risk. Conclusions: For patients with AF at the time of mitral operation, the performance of SA seems associated with a lower risk-adjusted operative mortality compared with patients who do not undergo ablation.
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U2 - 10.1016/j.athoracsur.2017.12.035
DO - 10.1016/j.athoracsur.2017.12.035
M3 - Article
C2 - 29391145
AN - SCOPUS:85043347721
SN - 0003-4975
VL - 105
SP - 1790
EP - 1796
JO - Annals of Thoracic Surgery
JF - Annals of Thoracic Surgery
IS - 6
ER -