Key result
Concomitant AF ablation during MV surgery is not linked to higher in-hospital mortality despite longer bypass.
Why the study?
Guidelines recommend concomitant surgical ablation for AF during mitral valve surgery, but national trends and early clinical outcomes in this UK cohort needed reporting.
Does concomitant surgical AF ablation affect early clinical outcomes in patients with preexisting atrial fibrillation undergoing isolated mitral valve surgery?
Cohort (n=3,497)
Yes
Does concomitant surgical AF ablation affect early clinical outcomes in patients with preexisting atrial fibrillation undergoing isolated mitral valve surgery?
Concomitant surgical AF ablation during mitral valve surgery increases procedural times but does not compromise short-term clinical outcomes.
Answers are grounded in this paper and cite their sources.
Supports short-term safety of concomitant ablation in mitral surgery; leaves open long-term efficacy and requires randomized confirmation.
Introduction European and American guidelines recommend concomitant surgical ablation for atrial fibrillation (AF) in patients undergoing mitral valve surgery. There is evidence that this intervention reduces the incidence of early and mid-term incidence of AF post-operatively. We aim to report the trend and early clinical outcomes in this cohort of patients in the United Kingdom. Method This study included all patients with underlying atrial fibrillation who underwent first-time, elective, or urgent isolated mitral valve repair/replacement from 2011 to April 2019. We evaluated the trend and early clinical outcomes between patients who did/did not receive surgical AF ablation and examined associated factors. Results A total of 3497 patients were included, with a median age of 70.6 years old (IQR: 63.1, 76.5), and 52.67% were male. The number of isolated mitral valve surgery performed ranges between 388 to 464 during the study period. The mitral valve repair rate was 62%. The overall AF ablation rate was 27.71% (Range: 16.74%-33.33%). After inverse propensity score matching, patients who underwent AF ablation had a significantly longer cardiopulmonary bypass (125 vs 99 mins, p < .001) and aortic cross-clamp time (92 vs 73 mins, p < .001). However, there was no difference in in-hospital mortality (2.03% vs 1.80%, p = .69), return to theatre for bleeding (5.82% vs 7.44%, p = .11), post-operative stroke (0.61% vs 0.48%, p = .11), post-operative dialysis (2.54% vs 2.40%, p = .83) and deep sternal wound infection (0.56% vs 0.88%, p = .34). Conclusion Patients with pre-existing atrial fibrillation undergoing concomitant surgical ablation during mitral valve intervention had a longer cardiopulmonary bypass and cross-clamp time without compromising short-term clinical outcomes. Long-term outcomes are required to examine the potential lasting benefit of surgical ablation.
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Chan et al. (2025) conducted a cohort in Preexisting atrial fibrillation undergoing isolated mitral valve surgery (n=3,497). Surgical AF ablation vs. No surgical AF ablation was evaluated on In-hospital mortality (p=0.69). Concomitant surgical ablation during mitral valve surgery in patients with atrial fibrillation did not significantly affect in-hospital mortality (2.03% vs 1.80%, p=0.69) despite longer bypass times.
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