Long-term Outcomes of Concomitant Left-sided Cryoablation during Totally Endoscopic Mitral Valve Surgery

Background: Concomitant atrial fibrillation (AF) ablation during mitral valve (MV) surgery is a well-established procedure and is recommended in guidelines. However, data on the long-term outcomes of cryoablation performed during totally endoscopic MV procedures remain limited. Therefore, we analyzed rhythm outcome and predictors of freedom from AF in patients undergoing concomitant left-sided cryoablation during totally endoscopic MV surgery.

Methods: Between 2016 and 2023, a total of 710 patients underwent totally endoscopic MV surgery at our center. Among them, 154 patients received concomitant left-sided cryoablation. A retrospective analysis was performed on 123 patients with available rhythm data. Left-sided cryoablation procedure entailed the creation of a box and isthmus line, in conjunction with the occlusion of the left atrial (LA) appendage. Rhythm evaluations were conducted based on either 24 hour-Holter electrocardiogram (ECG) or event recorder interrogation, performed after a minimum of 3 months of postoperative blanking period. A logistic regression model was employed for the purpose of statistical analysis.

Results: The mean age of the patients was 63.9 ± 11.2 years, with 56.9% of them being male. Of the patients, 53 (43.1%) exhibited paroxysmal AF, while 70 (56.9%) demonstrated persistent or longstanding, persistent AF. No complications related to the ablation procedure were observed in any of the patients. At a mean follow-up of 39.3 /− 24.3 months, freedom from AF was achieved in 89 patients (72.5%) in the overall cohort. Among patients with paroxysmal AF, 83.0% achieved freedom from AF, compared with 64.3% of those with non-paroxysmal AF (p < 0.001). The results of the multivariate logistic regression analysis indicated that non-paroxysmal AF (p = 0.028; OR: 4.04; 95% CI 1.16–14.0), larger LA volume (p = 0.015; OR: 1.02; 95% CI 1.0–1.04), and higher EuroScore II (p = 0.039; OR: 1.9; 95% CI 1.03–3.5) were negative predictors for a successful ablation.

Conclusion: Concomitant left-sided cryoablation during totally endoscopic MV surgery is a safe and effective procedure for the treatment of AF. Freedom of AF was achieved in 72.5% of the patients at mean follow-up of 39.3 months. Statistically significant predictors for freedom from AF were non-paroxysmal AF, EuroScore II, and LA volume.

Publication History

Article published online:
11 February 2025