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September 8, 2026Innovations Technology and Techniques in Cardiothoracic and Vascular Surgery

Surgical Ablation for Atrial Fibrillation During Minimally Invasive Mitral Valve Surgery: Risk Dependencies and Long-Term Survival

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Why the study?

Data are lacking regarding the safety and survival outcomes after surgical ablation concomitant to minimally invasive mitral valve surgery in patients with AF.

Does surgical ablation concomitant to minimally invasive mitral valve surgery improve survival and reduce complications in adult patients with atrial fibrillation?

Population

1,545 adult AF patients undergoing MIMVS (365 propensity score-matched pairs)

Comparison

MIMVS with concomitant surgical ablation vs MIMVS alone

Design

Retrospective national registry-based propensity score-matched study

Key result

Surgical ablation during minimally invasive mitral valve surgery did not significantly improve adjusted long-term survival (HR 0.85; 95% CI 0.56-1.32; P=0.48), but was associated with fewer neurologic complications.

Authors

MKMariusz KowalewskiGRGiuseppe Maria RaffaJBJakub Batko

Discussion

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Overview

May reduce neurologic complications in AF patients undergoing MIMVS; leaves open adjusted survival benefit in this observational cohort.

Key Points

  • To evaluate the safety profile and long-term survival associated with concomitant surgical ablation during minimally invasive mitral valve surgery in patients with atrial fibrillation.
  • Extracted clinical data from the Polish National Registry of Cardiac Surgery Procedures (2006–2021) for adult patients with atrial fibrillation undergoing minimally invasive mitral valve surgery (N=1,545).
  • Applied propensity score matching to compare patients who received concomitant surgical ablation against those who underwent mitral valve surgery alone, yielding 365 matched pairs.
  • Neurologic complications occurred significantly less often with concomitant ablation compared to surgery alone (2.7% vs 8.2%, P=0.002), with identical 24-hour mortality (0.3% vs 0.0%, P=0.99).
  • Unadjusted survival favored surgical ablation (HR=0.52, 95% CI: 0.40 to 0.69, P<0.001), but after adjusting for baseline risk factors, the survival benefit was not statistically significant (HR=0.85, 95% CI: 0.56 to 1.32, P=0.48).
  • Stratification by baseline CHA2DS2-VASc score demonstrated a gradient of benefit, where patients with the highest thromboembolic risk derived the greatest long-term survival advantage from ablation.

Study Design

Type

Cohort (n=1,545)

Multicenter

Yes

Structured PICO

Does surgical ablation concomitant to minimally invasive mitral valve surgery improve survival and reduce complications in adult patients with atrial fibrillation?

P
Population
1,545 adult patients with atrial fibrillation undergoing minimally invasive mitral valve surgery between 2006 and 2021, analyzed retrospectively via a national registry.
E
Exposure
Surgical ablation concomitant to minimally invasive mitral valve surgery
C
Comparator
Minimally invasive mitral valve surgery alone
O
Outcome
Long-term survivalhard clinical

Main Result

Hazard Ratio: 0.85 (95% CI 0.56–1.32)

p-value: p=0.48

Concomitant surgical ablation during minimally invasive mitral valve surgery in AF patients reduces neurologic complications and may offer survival benefits specifically in those with high thromboembolic risk.

Cite This Study

Kowalewski et al. (2026) conducted a cohort in Atrial fibrillation and mitral valve disease (n=1,545). Surgical ablation vs. Minimally invasive mitral valve surgery alone was evaluated on Long-term survival (adjusted) (HR 0.85, 95% CI 0.56-1.32, p=0.48). Surgical ablation during minimally invasive mitral valve surgery did not significantly improve adjusted long-term survival (HR 0.85; 95% CI 0.56-1.32; P=0.48), but was associated with fewer neurologic complications.

synapsesocial.com/papers/6a9fd79b58e84d0ff5b46602https://doi.org/10.1177/15569845261472462
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