Long-term results of atrial fibrillation surgery concomitant with mitral valve surgery: A propensity score-matched multicenter study

Min-Seok Kim; Hee Jung Kim; Hyung Gon Je; Yang Hyun Cho; Joon Bum Kim; Sak Lee; Seung Hyun Lee

doi:10.1016/j.jtcvs.2024.01.013

Long-term results of atrial fibrillation surgery concomitant with mitral valve surgery: A propensity score-matched multicenter study

J Thorac Cardiovasc Surg. 2024 Jan 16:S0022-5223(24)00026-6. doi: 10.1016/j.jtcvs.2024.01.013. Online ahead of print.

Authors

Min-Seok Kim¹, Hee Jung Kim², Hyung Gon Je³, Yang Hyun Cho⁴, Joon Bum Kim⁵, Sak Lee⁶, Seung Hyun Lee⁷

Affiliations

¹ Cardiovascular Center, Myongji Hospital, Goyang-si, South Korea.
² Department of Thoracic and Cardiovascular Surgery, Korea University Anam Hospital, Seoul, South Korea.
³ Department of Thoracic and Cardiovascular Surgery, Busan University Yangsan Hospital, Yangsan-si, South Korea.
⁴ Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Seoul, South Korea.
⁵ Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, Seoul, South Korea.
⁶ Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea.
⁷ Division of Cardiovascular Surgery, Severance Cardiovascular Hospital, Yonsei University College of Medicine, Seoul, South Korea. Electronic address: henry75@yuhs.ac.

PMID: 38237763
DOI: 10.1016/j.jtcvs.2024.01.013

Abstract

Objective: The aim of the study was to elucidate the long-term outcomes of atrial fibrillation surgery in patients with atrial fibrillation and mitral valve disease by comparing the patients who underwent mitral valve surgery with and without atrial fibrillation surgery.

Methods: Between 2005 and 2017, 2680 patients with atrial fibrillation who underwent mitral valve surgery (mitral valve surgery with atrial fibrillation surgery, n = 1841; mitral valve surgery without atrial fibrillation surgery, n = 839) at 5 centers were included. After propensity score matching, 1442 patients were extracted (atrial fibrillation surgery group, n = 721; non-atrial fibrillation surgery group, n = 721). All-cause mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, stroke or transient ischemic attack, and permanent pacemaker implantation were compared between the atrial fibrillation surgery and non-atrial fibrillation surgery groups.

Results: Overall survivals at 5 and 10 years postoperatively were 91.0% and 80.7% in the atrial fibrillation surgery group and 86.5% and 75.9% in the non-atrial fibrillation surgery group, respectively (P = .013). Cardiac mortality-free survivals at 5 and 10 years postoperatively were 96.9% and 91.7% in the atrial fibrillation surgery group and 90.9% and 83.7% in the non-atrial fibrillation surgery group, respectively (P < .001). Cumulative incidence of reoperation, major adverse cardiac and cerebrovascular events, and stroke or transient ischemic attack was lower in the matched atrial fibrillation surgery group compared with the matched non-atrial fibrillation surgery group up to 15 years postoperatively (P = .010, P < .001, and P = .012, respectively). Cumulative incidence of permanent pacemaker implantation was higher in the matched atrial fibrillation surgery group compared with the matched non-atrial fibrillation surgery group (P < .001).

Conclusions: In patients with atrial fibrillation and mitral valve disease, mitral valve surgery concomitant with atrial fibrillation surgery was associated with lower mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, and stroke or transient ischemic attack up to 15 years after surgery when compared with mitral valve surgery without atrial fibrillation surgery.

Keywords: atrial fibrillation; atrial fibrillation surgery; mitral valve.