Modern aspects in surgical treatment of atrial fibrillation with simultaneous mitral valve surgery via minimally invasive approach: evolution of techniques and analysis of clinical outcomes

Objective. To analyze the efficacy and specific features of surgical treatment of atrial fibrillation (AF) in mitral valve surgery via minimally invasive approach, as well as to compare the outcomes with those after conventional sternotomy. Material and methods. A systematic literature searching was conducted in the following electronic databases from their inception until June 2025: Ovid MEDLINE, EMBASE, and SCOPUS. The review examines modern atrial ablation techniques, including cryo- and radiofrequency ablation, as well as left atrial appendage exclusion methods. Comparative studies evaluating the effectiveness of minimally invasive versus standard approaches were analyzed. The authors focused on freedom from AF, complication rates and postoperative mortality. Results. Minimally invasive techniques demonstrate efficacy comparable to traditional approaches in AF treatment with freedom from atrial arrhythmias ranging from 78% to 99% within a year. Advantages of minimally invasive approach include shorter recovery time, lower complication rates (6% vs. 13%), and reduced need for pacemaker implantation (4% vs. 18%), as reported by various authors. Technological advancements in thermal ablation devices have improved precision and safety of procedures. Conclusion. Minimally invasive approach is a safe and effective alternative to conventional sternotomy for surgical treatment of AF combined with mitral valve repair. Further research should focus on optimizing techniques, refining patient selection criteria, and evaluating long-term outcomes.