Survival after surgical ablation for atrial fibrillation in mitral valve surgery: Analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK)

Piotr Suwalski; Mariusz Kowalewski; Marek Jasiński; Jakub Staromłyński; Marian Zembala; Kazimierz Widenka; Mirosław Brykczyński; Jacek Skiba; Michał Oskar Zembala; Krzysztof Bartuś; Tomasz Hirnle; Inga Dziembowska; Zdzisław Tobota; Bohdan J Maruszewski; KROK Investigators

doi:10.1016/j.jtcvs.2018.07.099

Survival after surgical ablation for atrial fibrillation in mitral valve surgery: Analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK)

J Thorac Cardiovasc Surg. 2019 Mar;157(3):1007-1018.e4. doi: 10.1016/j.jtcvs.2018.07.099. Epub 2018 Sep 8.

Authors

Collaborators

KROK Investigators:
Lech Anisimowicz, Andrzej Biederman, Dariusz Borkowski, Paweł Bugajski, Paweł Cholewiński, Romuald Cichoń, Marek Cisowski, Marek Deja, Antoni Dziatkowiak, Tadeusz Gburek, Leszek Gryczko, Ireneusz Haponiuk, Piotr Hendzel, Stanisław Jabłonka, Krzysztof Jarmoszewicz, Jarosław Jasiński, Ryszard Jaszewski, Marek Jemielity, Ryszard Kalawski, Bogusław Kapelak, Jacek Kaperczak, Maciej A Karolczak, Michał Krejca, Wojciech Kustrzycki, Mariusz Kuśmierczyk, Paweł Kwinecki, Maurycy Missima, Jacek J Moll, Wojciech Ogorzeja, Jacek Pająk, Wojciech Pawliszak, Edward Pietrzyk, Grzegorz Religa, Jan Rogowski, Jacek Różański, Jerzy Sadowski, Girish Sharma, Janusz Skalski, Ryszard Stanisławski, Janusz Stążka, Piotr Stępiński, Kazimierz Suwalski, Łukasz Tułecki, Michał Wojtalik, Stanisław Woś, Piotr Żelazny

Affiliations

¹ Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Clinical Department of Cardiac Surgery, Centre of Postgraduate Medical Education, Warsaw, Poland.
² Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland; Cardiothoracic Research Centre, Collegium Medicum, Nicolaus Copernicus University, Bydgoszcz, Poland. Electronic address: kowalewskimariusz@gazeta.pl.
³ Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland.
⁴ Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Warsaw, Poland.
⁵ Department of Cardiac, Vascular, and Endovascular Surgery and Transplantology, School of Medicine, Medical University of Silesia, Katowice, Poland; Division of Dentistry in Zabrze, Medical University of Silesia, Katowice, Poland; Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Disease, Zabrze, Poland.
⁶ Clinical Department of Cardiac Surgery, District Hospital No. 2, University of Rzeszów, Rzeszów, Poland.
⁷ Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland.
⁸ Department of Cardiac Surgery, 4 Military Clinical Hospital Centre for Heart Diseases, Wroclaw, Poland.
⁹ Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland.
¹⁰ Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland.
¹¹ Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland.
¹² Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland.

PMID: 30314688
DOI: 10.1016/j.jtcvs.2018.07.099

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 ± 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 ± 8.7 years vs 66.1 ± 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.

Keywords: atrial fibrillation; long-term results; mitral valve; registry; surgical ablation.