Safety of Atrial Fibrillation Ablation With Isolated Surgical Aortic Valve Replacement

Churyla, Andrei; Andrei, Adin-Cristian; Kruse, Jane; Cox, James L.; Kislitsina, Olga N.; Liu, Menghan; Malaisrie, S. Chris; McCarthy, Patrick M.

doi:10.1016/j.athoracsur.2020.06.015

Cited by 16 publications

(18 citation statements)

References 20 publications

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“…Previous studies have demonstrated the benefits of concomitant AF ablation during cardiac surgery, including MV surgery (1-3); current guidelines make a class I recommendation to perform concomitant surgical ablation of AF during cardiac surgery (4). Although previous studies reported a higher occurrence rate of AKI in cardiac surgery patients who underwent concomitant maze procedure (2,6), recent guidelines state that concomitant maze procedure does not increase the incidence of postoperative dialysis or renal failure (14). This may be partly due to the lack of standardized criteria for the diagnosis of AKI.…”

Section: Discussionmentioning

confidence: 99%

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Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

Hong¹,

Lee²,

Kim³

et al. 2022

J Thorac Dis

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Background: Acute kidney injury (AKI) is one of the most common complications after cardiac surgery.While current guidelines indicate that surgical ablation does not increase the risk of renal failure, recent studies have produced conflicting results. This study was conducted to evaluate the incidence of AKI after maze procedure in patients with rheumatic mitral valve disease and atrial fibrillation, and to elucidate risk factors associated with postoperative AKI.Methods: Between 2011 and 2020, 203 patients with rheumatic mitral valve disease and atrial fibrillation (61.4±8.7 years, male:female =67:136) who underwent concomitant maze procedure and mitral valve replacement were retrospectively reviewed. Other combined procedures included aortic valve operations (n=64, 31.5%) and tricuspid valve procedures (n=149, 73.4%). The AKI was defined as an increase of serum creatinine level by 1.5 times after surgery based on the RIFLE (Risk, Injury, Failure, Loss, and End stage) criteria. A multivariable logistic regression analysis was performed to evaluate risk factors associated with postoperative AKI.Results: Postoperative AKI developed in 76 patients (37.4%). The multivariable analysis demonstrated that age (odds ratio, 95% CI: 1.065, 1.025-1.107; P=0.001), cardiopulmonary bypass (CPB) time (1.007, 1.002-1.013; P=0.009) and nadir hematocrit during CPB (0.854, 0.740-0.985; P=0.031) were associated with postoperative AKI.Conclusions: Postoperative AKI occurred in more than one thirds of patients with rheumatic mitral valve disease and atrial fibrillation who underwent combined mitral valve replacement and maze procedure.Optimization of CPB management might be needed to prevent postoperative AKI after maze procedure.

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Section: Discussionmentioning

confidence: 99%

“…Current guidelines suggest that surgical ablation does not increase the risk of renal failure or dialysis (4). However, the rate of postoperative acute kidney injury (AKI) was increased in previous studies (5,6). A previous study also showed that the development of postprocedural AKI is associated with an increase mortality (7).…”

Section: Introductionmentioning

confidence: 99%

Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

Hong¹,

Lee²,

Kim³

et al. 2022

J Thorac Dis

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“…A retrospective study conducted on 87,426 patients who underwent surgical valve replacement revealed that AF ablation would not increase the risk of mortality and stroke, but indicated the requirements of a pacemaker. [ 28 ] This retrospective study with a large sample size explored an idea similar to ours. We not only used the fixed-effect model but also the relatively conservative random-effect model to evaluate the overall effect size, which revealed a similar significance (random-effect model: RR 1.81, 95% CI [1.11, 2.96], I 2 0%, P = .02).…”

Section: Discussionmentioning

confidence: 99%

“…All-cause mortality (RR 0.98, 95% CI [0.64, 1.51], I 2 0%, P = .94) and stroke (RR 1.29, 95% CI [0.70, 2.39], I 2 0%, P = .57) were similar in the VSA and VS groups. Compared with VS, VSA prolonged cardiopulmonary bypass time (MD 30.44, 95% CI [17.55, 43.33], I 2 88%, P < .00001) and aortic cross-clamping time (MD 19.57, 95% CI [11.10,28.03], I 2 89%, P < .00001). No significant differences were found between groups with respect to the risk of bleeding (RR 0.64, 95% CI [0.37, 1.12], I 2 0%, P = .12), heart failure (RR 1.11, 95% CI [0.63, 1.93], I 2 0%, P = .72), and low cardiac output syndrome (RR 1.41, 95% CI [0.57, 3.46], I 2 18%, P = .46).…”

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confidence: 99%

Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

Wang¹,

Wu²,

Zhang³

et al. 2021

Medicine

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Background: Atrial fibrillation is the main complication of patients who suffer from valvular heart disease (VHD), which may lead to an increased susceptibility to ventricular tachycardia, atrial dysfunction, heart failure, and stroke. Therefore, seeking a safe and effective therapy is crucial in prolonging the lives of patients with VHD and improving their quality of life. Methods: Our target database included PubMed, Web of Science, Embase, and Cochrane Library, from which published articles were retrieved from inception to June 2020. We retrieved all randomized controlled trials (RCTs) that compared patients undergoing valve surgery with (VSA) or without ablation (VS) procedure. Studies to be included were screened and data extraction was performed independently by 2 investigators. The Cochrane risk-of-bias table was used to evaluate the methodological quality of the included RCTs. The mean difference (MD) with 95% confidence interval (CI) and relative risk (RR) ratio was calculated to analyze the data. Heterogeneity was evaluated using I 2 and chi-square tests. Egger test and the trim and fill analysis were used to further determine publication bias. Results: Fourteen RCTs that included 1376 patients were eventually selected for this meta-analysis. Surgical ablation was found to be effective in restoring sinus rhythm in valvular surgery patients at discharge (RR 2.91, 95% CI [1.17, 7.20], I 2 97%, P = .02), 3 to 6 months (RR 2.85, 95% CI [2.27, 3.58], I 2 49%, P < .00001), 12 months, and more than 1 year after surgery (RR 3.54, 95% CI [2.78, 4.51], I 2 27%, P < .00001). All-cause mortality (RR 0.98, 95% CI [0.64, 1.51], I 2 0%, P = .94) and stroke (RR 1.29, 95% CI [0.70, 2.39], I 2 0%, P = .57) were similar in the VSA and VS groups. Compared with VS, VSA prolonged cardiopulmonary bypass time (MD 30.44, 95% CI [17.55, 43.33], I 2 88%, P < .00001) and aortic cross-clamping time (MD 19.57, 95% CI [11.10, 28.03], I 2 89%, P < .00001). No significant differences were found between groups with respect to the risk of bleeding (RR 0.64, 95% CI [0.37, 1.12], I 2 0%, P = .12), heart failure (RR 1.11, 95% CI [0.63, 1.93], I 2 0%, P = .72), and low cardiac output syndrome (RR 1.41, 95% CI [0.57, 3.46], I 2 18%, P = .46). However, the demand for implantation of a permanent pacemaker was significantly higher in the VSA group (RR 1.84, 95% CI [1.15, 2.95], I ...

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“…Thus, threefold stroke reduction after LAA amputation in our cohort with concomitant AF and leading aortic stenosis regardless of CHA2DS2-VASc score identifies patients potentially benefiting from LAA occlusion the most. At present, typically only 20% of patients with concomitant AF received LAA closure at the time of AVR [ 24 ], possibly reflecting the fact that nowadays, many centers operate on the aortic valve using a minimally invasive approach with peripheral cannulation whereby the LAA amputation in this setting might not be the easiest maneuver to do. As less invasive approaches are increasingly used for surgical AVR with appealing outcomes [ 25 ], we estimate that life-saving LAA interventions could be performed more often by using an epicardial device in order to overcome the issues of limited accessibility.…”

Section: Commentmentioning

confidence: 99%

Left Atrial Appendage Amputation for Atrial Fibrillation during Aortic Valve Replacement

Kališnik

Santarpino

Balbierer

et al. 2022

JCM

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Background. Occluding the left atrial appendage (LAA) during cardiac surgery reduces the risk of ischemic stroke; nonetheless, it is currently only softly recommended with “may be considered” by the current guidelines. We aimed to assess thromboembolic risk after LAA amputation in patients with atrial fibrillation (AF) and aortic stenosis undergoing biological aortic valve replacement (AVR) as primary cardiac surgery. Methods. Two cohorts were generated retrospectively: patients with AF undergoing AVR alone or combined with revascularization either with LAA amputation or without. Data were collected from the hospital-specific data system. Follow-up was completed by telephone interview or in person. Thirty-day and follow-up results were compared in patients with vs. without LAA amputation. Results. One hundred and fifty-seven patients were investigated retrospectively, and seventy-four pairs were matched with regard to baseline characteristics. Patients with LAA amputation exhibited a lower incidence of cumulative and late ischemic stroke (6.4% vs. 25%, p = 0.028 and 3.2% vs. 20%, p = 0.008, respectively; hazard ratio 0.30; 95% confidence interval 0.11; 0.84; p = 0.021) during follow-up of 48 months vs. patients without intervention during follow-up of 45 months, p = 0.494. No significant differences were observed in postoperative stroke, 2 (2.7%) vs. 3 (4.1%), p = 1.000, re-exploration for bleeding 3 (4.1%) vs. 6 (8.1), p = 0.494 or late pericardial effusion 2 (2.7%) vs. 3 (4.1%), p = 1.000, in-hospital 2 (2.7%) vs. 4 (5.4%), p = 0.681 and all-cause mortality 15 (23.8%) vs. 9 (15%), p = 0.315 in patients with vs. without LAA amputation, respectively. Conclusions. A combination of leading aortic stenosis and AF in patients undergoing isolated or combined biological AVR represents a subpopulation with excessive thromboembolic risk. Concomitant LAA amputation during cardiac surgery reduces the risk of ischemic stroke without posing an additional periprocedural risk for the patient. Therefore, the minimal invasive approach at the expense of omitting LAA amputation should be discouraged to maximize the clinical benefits of AVR in this setting.

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Safety of Atrial Fibrillation Ablation With Isolated Surgical Aortic Valve Replacement

Cited by 16 publications

References 20 publications

Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

Incidence and risk factors of acute kidney injury after maze operation in patients with rheumatic mitral valve disease

Efficiency and safety of ablation procedure for the treatment of atrial fibrillation in valve surgery

Left Atrial Appendage Amputation for Atrial Fibrillation during Aortic Valve Replacement

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