Atrial fibrillation ablation improves late survival after concomitant cardiac surgery

Mariusz Kowalewski*, Michał Pasierski, Michalina Kołodziejczak, Radosław Litwinowicz, Adam Kowalówka, Wojciech Wańha, Andrzej Łoś, Sebastian Stefaniak, Wojciech Wojakowski, Marek Jemielity, Jan Rogowski, Marek Deja, Krzysztof Bartuś, Silvia Mariani, Tong Li, Matteo Matteucci, Daniele Ronco, Giulio Massimi, Federica Jiritano, Paolo MeaniGiuseppe Maria Raffa, Pietro Giorgio Malvindi, Michał Zembala, Roberto Lorusso, James L Cox, Piotr Suwalski, Thoracic Research Centre

*Corresponding author for this work

Research output: Contribution to journalArticleAcademicpeer-review

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Abstract

OBJECTIVE: Preoperative atrial fibrillation (AF) increases risk of stroke, heart failure, and all-cause mortality after cardiac surgery. Despite encouraging results and guideline recommendations, surgical ablation (SA) for AF concomitant with other heart surgery remains low. In the current study we aimed to address the long-term mortality after SA concomitant with cardiac surgery.

METHODS: This report pertains to the HEart surgery In atrial fibrillation and Supraventricular Tachycardia (HEIST) registry. We identified 20,765 adult patients (62% male) with preoperative AF who underwent conventional sternotomy heart surgery between 2010 and 2021 in 8 tertiary centers in Poland, Netherlands, and Italy. We used Cox proportional hazards models for computations and propensity score matching to minimize differences in baseline characteristics.

RESULTS: Of included patients, 2755 (13.4%) underwent SA for AF. The highest rates of SA were observed for mitral interventions (mitral valve repair or replacement and tricuspid intervention, 25.2%), lowest for isolated coronary artery bypass grafting (6.2%). Patients in the SA group were younger (mean age 64.5 ± 9.0 years vs 68.7 ± 16.0 years; P < .001) and lower risk (mean European System for Cardiac Operative Risk Evaluation [EuroSCORE] II, 4.1 vs 5.7; P < .001). During the 11-year study period, there was a mortality reduction associated with SA (hazard ratio, 0.57; 95% CI, 0.52-0.62; P < .001). After propensity matching, 2750 pairs with similar baseline characteristics were identified. SA was associated with 16% mortality decline (hazard ratio, 0.84; 95% CI, 0.75-0.94; P = .003).

CONCLUSIONS: In this multicenter, retrospective, propensity matched study, SA concomitant with other cardiac surgery was associated with improved long-term survival regardless of baseline surgical risk.

Original languageEnglish
Pages (from-to)1656-1668.e8
Number of pages21
JournalJournal of Thoracic and Cardiovascular Surgery
Volume166
Issue number6
Early online date14 May 2022
DOIs
Publication statusPublished - Dec 2023

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