Impact of Concomitant Surgical Atrial Fibrillation Ablation in Patients Undergoing Endoscopic Mitral Valve Surgery

Background: Atrial fibrillation (AF) is frequently associated with mitral regurgitation (MR) resulting in an increased morbidity and mortality. Concomitant AF ablation during open-heart surgery is effective, safe, and recommended in current guidelines. Nevertheless, the outcome of concomitant AF ablation during endoscopic mitral valve surgery (endMVS) remains to be investigated.

Methods: Between 2012 and 2022, 1,037 consecutive patients underwent endMVS via right-sided anterolateral skin incision and 3D-camera visualization. Patients were categorized according to the prevalence of preoperative AF (group 1: no AF; n = 699) and concomitant AF ablation (group 2: AF and ablation; n = 188; group 3: AF no ablation; n = 146). Data was retrospectively analyzed.

Results: Patients without AF were significantly younger (group 1: 58.0 [55.0–66.2] versus group 2: 66.0 [58.0–71.0] versus group 3: 65.0 [57.0–72.0] years) (p < 0.001) and presented with a lower prevalence of hypertension (p < 0.001), diabetes (p < 0.020), and coronary artery disease (p = 0.002). Accordingly, median STS PROM Score was significantly lower in group 1 (0.3 [0.2–0.6] versus 0.5 [0.3–0.9] versus 0.6 [0.4–1.2]; p < 0.001). In group 1 patients were less symptomatic, showed lower levels of NT-proBNP, and better left and right ventricular function (all p < 0.001). Secondary MR was less frequent in group 1 (8.2 versus 26.0 versus 22.2; p < 0.001). MV repair was achieved in 94.4% versus 91.5% versus 85.6% (p < 0.001). Median procedural (p = 0.079) and cross clamp (p = 0.27) times were comparable between groups. Postoperative ventilation time, length of stay in ICU, and in-hospital stay (all p < 0.001) differed significantly between groups. Permanent pacemaker implantation rates were comparable between groups (2.7 versus 4.8 versus 4.9%; p = 0.22). Perioperative AF occurred in 21.8 versus 76.1 versus 71.2% of patients (p < 0.001), whereas sinus rhythm at discharge was reported in 84.9 versus 58 versus 51.4% (p < 0.001). At 30 days, overall mortality was 0.6 versus 0.5 versus 1.4% (p = 0.55). Survival rates (p = 0.019) as well as rates of freedom from reoperation or death (p = 0.045) at 60 months differed significantly between groups, showing worst outcome in patients having AF without receiving surgical ablation (group 3).

Conclusion: Despite an increased prevalence of comorbidities and surgical risk, outcome of patients with AF undergoing endMVS is excellent. Concomitant AF ablation is safe and feasible and does not increase perioperative complications rates, but potentially improves long-term outcome.

Publikationsverlauf

Artikel online veröffentlicht:
11. Februar 2025