Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Abstract

Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

Impact of frailty status on clinical and functional outcomes after concomitant valve replacement and bipolar radiofrequency ablation in patients aged 65 years and older

“…Nakamura et al reported that the rate of freedom from AF in 143 patients (age 65 years or older) with concomitant surgical ablation was 74.9% [18]. The question of whether to perform BRFA in older patients with valvular disease combined with AF simultaneously has been previously explored in several studies [7][8][9][10], including one of our own [14], and some well-known risk factors, such as age, body mass index, and left atrial size, have been shown to adversely affect patients undergoing heart valve surgery combined with AF ablation [19][20][21]. However, to our knowledge, comparative clinical data on risk stratification using a frailty index in older patients undergoing surgical radiofrequency ablation techniques for concurrent AF are lacking.…”

“…VR with concomitant BRFA was initially performed under general anesthesia with hypothermic cardiopulmonary bypass through a median sternotomy. The surgical technique details and postoperative treatment (anti-arrhythmic therapy, control of ventricular rate, and anticoagulation) have been described in our previous paper [14]. The Medtronic Cardioblate G2 Surgical Ablation System (Medtronic Inc., Minneapolis, MN) with a bipolar radiofrequency clamp was used for surgical ablation.…”

Impact of frailty status on clinical and functional outcomes after concomitant valve replacement and bipolar radiofrequency ablation in patients aged 65 years and older

“…[10] including one of our own, [13] and some well-known risk factors, such as age, body mass index, and left atrial size, have been shown to adversely affect patients undergoing heart valve surgery combined with AF ablation; [17] , [18] , [19] however, to our knowledge, comparative clinical data on risk strati cation using a frailty index in elderly patients undergoing surgical radiofrequency ablation techniques for concurrent AF are lacking. Surgeons often refuse to perform concomitant BRFA because of the patient's frailty.…”

“…The surgical technique details and postoperative treatment (Anti-arrhythmia, control ventricular rate and anticoagulation) has been described in our previous paper. [13] The Medtronic Cardioblate G2 Surgical Ablation System (Medtronic Inc., Minneapolis, MN) with a bipolar radiofrequency clamp was used for surgical ablation. After surgical procedures, patients were admitted to the ICU for early monitoring before being transferred to the general cardiology ward.…”