The 2 lesion sets (left atrial and BA) are associated with similar 30-day mortality, survival rates, incidences of embolic events and atrioventricular conduction disturbances. In patients with persistent atrial fibrillation, concomitant surgical ablation with BA lesion set provided better freedom from atrial arrhythmia recurrence, but BA ablation was associated with a higher incidence of sinus node dysfunction and a higher rate of pacemaker implantation.
For patients undergoing the Ross procedure, a combination of bicuspid aortic valves and aortic insufficiency is the main risk factor for late autograft dilatation and dysfunction.
We evaluated the differences in mitral valve (MV) plasty (MVP) and MV replacement (MVR) with respect to death, postoperative MV dysfunction, reoperation rates and thromboembolic events (DFRE) in patients with hypertrophic obstructive cardiomyopathy and systolic anterior motion of the anterior mitral leaflet-mediated MV regurgitation (HOCM & MR). We followed the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines, searching PubMed, Cochrane library and ClinicalTrials.gov for studies that evaluated DFRE in adults with HOCM & MR after MVP/MVR. We used a risk of bias assessment tool for non-randomized studies, and analyses were performed using Cochrane Review Manager 5.3.5 for I2 statistics, funnel plots and forest plot and the generic inverse variance method for hazard ratios (HRs). We developed qualitative and quantitative syntheses of 35 and 23 studies, respectively, including levels of evidence of ½/3/4/5 = 3/1/11/11/9 and ½/3/4/5 = 0/1/11/11/0, respectively, from January 1980 to August 2017. A statistically significant difference between MVP and MVR favoured MVP for the prevention of DFRE in patients with HOCM & MR, on the basis of a significant reduction of the HR for DFRE: HR = 0.68 (0.57, 0.82), I2 = 68% (P = 0.002). The findings were as follows: (i) MVP should be the first-line treatment in patients with HOCM & MR (accuracy LEVEL A) and (ii) MVR may be harmful if it is used as the first-line treatment (accuracy LEVEL A).
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