Surgical ablation for persistent atrial fibrillation in concomitant cardiac surgery: mid-long-term result†

Gu, Wenda; Guo, Huimin; Liu, Cong; Huang, Huanlei; Liu, Jing; Liu, Jian; Xie, Bo; Wu, Ruo-bin; Chen, Jimei; Zhuang, Jian

doi:10.1093/ejcts/ezx179

Cited by 20 publications

(21 citation statements)

References 19 publications

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“…Ad et al also demonstrated improved quality of life through SF-12 and AF-specific questionnaire in the elderly cohort > 75 years who had concomitant Cox-Maze IV [18]. Gu et al showed patients who were restored to SR postoperatively had significantly better NYHA status compared to those in AF [29]. They also demonstrated significantly improved LVF and decreased size of LA and RA [29].…”

Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation in Elderly Patients Undergoing High Risk Cardiac Surgery

Uzzaman¹,

Manoly

Panikkar

et al. 2021

Preprint

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BACKGROUND/AIM To evaluate outcomes of concurrent Cox-Maze procedures in elderly patients undergoing high-risk cardiac surgery. MEHODS We retrospectively identified patients aged over 70 years with Atrial Fibrillation (AF) from 2011 to 2017 who had two or more other cardiac procedures. They were subdivided into two groups: 1. Cox-Maze IV AF ablation 2. No-Surgical AF treatment. Patients requiring redo procedures or those who had isolated PVI or LAAO were excluded. Heart rhythm assessed from Holter reports or 12-lead ECG. Follow-up data collected through telephone consultations and medical records. RESULTS There were 239 patients. Median follow up was 61 months. 70 patients had Cox-Maze IV procedures (29.3%). Demographic, intra- and post-operative outcomes were similar between groups although duration of pre-operative AF was shorter in Cox-Maze group (p=0.001). One (1.4%) patient in Cox maze group with 30-day mortality compared to 14 (8.2%) the control group (p=0.05). Sinus rhythm at annual and latest follow-up was 84.9% and 80.0% respectively in Maze group - significantly better than No-Surgical AF treatment groups (P<0.001). 160 patients (66.9%) were alive at long-term follow-up with better survival curves in Cox Maze group compared to No-Surgical treatment group (p=0.02). There was significantly higher proportion of patients in NYHA 1 status in Cox-Maze group (p=0.009). No differences observed in freedom from stroke (p=0.80) or permanent pacemaker (p=0.33). CONCLUSIONS. Surgical ablation is beneficial in elderly patients undergoing high-risk surgery - promoting excellent long-term freedom from AF and symptomatic/prognostic benefits. Therefore, surgical risk need not be reason to deny benefits of concomitant AF-ablation.

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Section: Discussionmentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation in Elderly Patients Undergoing High Risk Cardiac Surgery

Uzzaman¹,

Manoly

Panikkar

et al. 2021

Preprint

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“…Cardiopulmonary bypass was established via aorto-bicaval cannulation. For surgical ablation (SA), the standard Cox-Maze IV procedure was performed using a Medtronic radiofrequency ablation kit (14)(15)(16). The LA appendage was routinely cut and oversewn.…”

Section: Surgical Techniquementioning

confidence: 99%

Mitral valve repair and surgical ablation for atrial functional mitral regurgitation

Chen

Wang

et al. 2020

Ann Transl Med

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Background: This observational study aimed to share our experience in the surgical management of atrial functional mitral regurgitation (AFMR).Methods: We retrospectively identified 82 AFMR patients (63.6±7.7 years) from June 2008 to November 2018 at our institution. Of these patients, 72.0% of them were classified as NYHA functional class III/IV, and all of them had persistent AF. All patients underwent mitral valve (MV) repair, and 52 (63.4%) received concomitant surgical ablation (SA). Patients were followed up for 26.1±27.6 months, and postoperative mitral regurgitation (MR) was assessed by echocardiography.Results: There was no in-hospital mortality. The overall 1-year and 3-year survival rates were 97.5% and 92.9%, respectively, and 96.1% of patients recovered to NYHA functional class I/II at the latest followup. The left atrium (LA) diameter (P<0.001), left ventricular (LV) end-diastolic diameter (P<0.001), LV end-systolic diameter (LVESD) (P<0.001) and pulmonary artery pressure (P=0.006) significantly decreased postoperatively. The overall 1-year and 3-year freedom from recurrent MR rates were 94.3% and 65.3%, respectively, and a significant difference was found between the SA group and the non-SA group (93.8% and 93.8% vs. 95.5% and 44.2%, P=0.035). In a subgroup analysis, this significant difference was only found in the small LA group (≤60 mm).Conclusions: Our results suggest that MV repair for AFMR is safe and effective. It improves heart failure symptoms and results in reverse-remodeling of both the LA and LV. Concomitant SA might benefit patients in terms of recurrent MR, especially in the small LA group (≤60 mm).

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“…Although not certain, the biatrial lesion set appears to display superiority to isolated LA lesion set in prevention of AF recurrence [78,80]. In addition, modifiable risk factors such as hypertension, diabetes and smoking are implicated in surgical ablation failure [81].…”

Section: Predictors Of Af Recurrence Following Surgical Ablationmentioning

confidence: 99%

Surgical Treatment of Atrial Fibrillation

Navaratnarajah¹,

Luthra²,

Ohri³

2020

Epidemiology and Treatment of Atrial Fibrillation

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The concepts, techniques and evidence relating to surgical ablation of atrial fibrillation are discussed in detail. The historical background to surgical ablation is covered in brief, along with the electrophysiological basis underpinning its effective useage. The epidemiology of surgically treated atrial fibrillation and the current guidelines relating to its use are analysed. Safety aspects and perspectives on its ongoing future use are discussed. Modern surgical technologies and approaches are reviewed, along with the relevant advantages and disadvantages of each. The surgical techniques relating to left atrial appendage intervention are also reviewed, along with the relevant literature and evidence relating to reduction in thromboembolic risk and need for anticoagulation.

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Surgical ablation for persistent atrial fibrillation in concomitant cardiac surgery: mid-long-term result†

Cited by 20 publications

References 19 publications

Surgical Treatment of Atrial Fibrillation in Elderly Patients Undergoing High Risk Cardiac Surgery

Surgical Treatment of Atrial Fibrillation in Elderly Patients Undergoing High Risk Cardiac Surgery

Mitral valve repair and surgical ablation for atrial functional mitral regurgitation

Surgical Treatment of Atrial Fibrillation

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