Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right‐Sided Heart Remodeling After Mitral‐Valve Surgery: A Propensity‐Score Matching Analysis

Abstract

BackgroundThis study assessed the role of surgical ablation for atrial fibrillation (AF) in decreasing tricuspid regurgitation (TR) and right‐sided heart remodeling in patients after mitral valve procedure.Methods and ResultsBetween 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity‐score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate‐to‐severe TR, as well as echocardiography indices in long‐term follow‐up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [HR], 1.644; 95% CI, 1.081–2.501; P=0.020), reoperation (HR, 2.644; 95% CI, 1.299–5.466; P=0.008), and moderate‐to‐severe TR (HR, 1.436; 95% CI, 1.059–1.948; P=0.020), associated with a significantly deteriorated cardiac function, progression of TR, and right‐sided heart remodeling after 5‐year follow‐up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5‐year follow‐up. The recurrent group showed significantly higher risks of moderate‐to‐severe TR (HR, 2.427; 95% CI, 1.261–4.671; P=0.008). AF recurrence was associated with progressive TR and significant deterioration in right‐sided heart remodeling.ConclusionsIn a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right‐sided heart remodeling, which are alleviated by surgical ablation.

Inferior Vena Cava Filter Retrieval Trends: A Single-Center Experience

“…Others have found a substantial increase in retrieval rates (up to 90%) when certain follow-up strategies were implemented after filter placement. [19][20][21][22][23] These include use of multidisciplinary teams, standardized protocols, patient education, automated reminder, or referral systems and creation of dedicated VCF clinics. Such a standardized, structured follow-up program was not utilized at our institution during the study period, and despite limited data showing efficacy in increasing filter retrieval, a specific recommendation is not present in current guidelines.…”

“…Subsequent studies have reported that the incidence of these complications increases with prolonged use of filters 13 and a decision analysis study found that the risk/benefit profile favors filter removal between 29 and 54 days. 14 Despite an increase in VCF retrieval in the United States following the 2010 FDA advisory statement [15][16][17][18] and several studies reporting retrieval rates of up to 85% following the implementation of structured follow-up programs, [19][20][21][22][23] at a national level, VCF retrieval rates remain low with an estimated average of 25 to 30% at 1 year. 13,16,18,24,25 European retrieval rates tend to be higher but vary from approximately 40 9,26 to 77% at 1 year.…”

Improvement in tricuspid regurgitation following catheter ablation of atrial fibrillation

“…Patients with persistent AF develop tricuspid annular dilation, especially along the posterior border of the valve, resulting in TR 10 . Conversely, surgical ablation of AF has been associated with improved cardiac function and interruption of TR progression in patients who are undergoing surgical correction of mitral regurgitation 11,12 …”

Higher Incidence of Atrial Fibrillation in Left Ventricular-to-Right Atrial Shunt Patients

“…Moreover, left-sided heart disease with AF was associated with TR progression as well as right-sided heart remodeling. These changes were alleviated by surgical ablation (Wang et al, 2016 ).…”