Comparative Efficacy Of Surgical Ablation During Mitral Valve Surgery: Minimally Invasive Versus Full-sternotomy Approach
Ho Jin Kim, Joon Bum Kim, Sung-Ho Jung, Suk Jung Choo, Cheol Hyun Chung, Jae Won Lee.
Asan Medical Center, Seoul, Korea, Republic of.
Background: Whether surgical ablation can be safely and efficaciously performed during concomitant minimally invasive mitral valve (MV) surgery (MIMVS) has rarely been investigated. This study aimed to evaluate the clinical outcomes of surgical ablation after MIMVS, compared to MV surgery with conventional full-sternotomy approach. Methods: Between January 2001 and September 2018, surgical ablation was performed for 1,272 patients (mean age 57.6 ± 11.8 years; 718 women) with preoperative atrial fibrillation (AF) during concomitant MV surgery in our institute. Among them, 537 (42.2%) and 735 (57.8%) patients underwent MV surgery via minimally invasive approach (MIMVS group) and full-sternotomy (non-MIMVS group), respectively. Surgical and rhythm-related outcomes between the 2 groups were analyzed after adjustment with propensity scores (PS). Results: Early death occurred in 29 (3.9%) and 9 (1.7%) in MIMVS and non-MIMVS group, respectively. AF recurred more frequently in non-MIMVS group within 3 months after surgery, compared to MIMVS group (61.5% vs. 55.3%, P=0.031), whereas permanent pacemaker (PPM) insertion (3.7% vs. 2.6%, P=0.367) and stroke (2.4% vs. 1.7%; P=0.455) were equivalent for both groups. After PS matching, 439 well-balanced pairs were generated. In the PS-matched models, there was no significant between-group differences in the risk of early death (odds ratio [OR], 0.63; 95% confidence interval [CI], 0.26-1.46; P=0.295), early PPM insertion (OR, 0.72; 95% CI, 0.35-1.46; P=0.377). During follow-up, 68 (7.8%) patients experienced AF recurrence after the blanking period (3 months), and the AF-free rate was equivalent for both groups (log rank P= 0.183). Conclusions: Surgical ablation via minimally invasive approach may be safe and effective as conventional full-sternotomy during MV surgery in patients with similar risk profiles.
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