Survival After Surgical Ablation For Atrial Fibrillation In Minimally Invasive Mitral Valve Surgery. Analysis From Krok Registry
Mariusz Kowalewski1, Marek Jasiński1, Jakub Staromłyński1, Marian Zembala2, Kazimierz Widenka3, Michał O. Zembala2, Krzysztof Bartuś4, Michał Pasierski1, Michał Krejca5, Witold Gerber6, Zdzisław Tobota7, Bohdan Maruszewski7, Piotr Suwalski1
1CSK MSWiA, Warsaw, Poland, 2SCCS, Zabrze, Poland, 3District Hospital no. 2, Rzeszów, Poland, 4Jagiellonian University, Kraków, Poland, 5Clinical Department of Cardiac Surgery, Łódź, Poland, 6Department of Cardiac Surgery, American Heart of Poland, Bielsko-Biała, Poland, 7CZD, Warsaw, Poland
Background
Surgical ablation for atrial fibrillation (AF) performed at the time of other valvular- or non-valvular cardiac procedure is a mainstay of therapy; yet the data regarding its impact on remote survival are sparse and in particular in the setting of minimally invasive mitral valve surgery (MIMVS). Current investigation aimed to evaluate late survival in patients undergoing mitral valve (MIMVS) with concomitant surgical ablation for AF.MethodsProcedural data from KROK (Polish Nationwide Heart Surgery Registry) were retrospectively collected. 1,013 patients with baseline AF (484 [47.8]% men, mean age 64.1±9.9) undergoing MV surgery between 2006-2019 in 37 reference centers across Poland and included in the registry were analyzed. Median follow-up was 5 years (4.7 IQR 2.3-5.7). Cox proportional hazards models were used for computations. Propensity score matching for the comparison MIMVS+ablation vs MIMVS alone was performed.ResultsOf included patients, 371 (36.6%) underwent surgical ablation. Patients in this group were significantly younger (63.1±9.6 vs 64.8±10.1; p=0.009) but were at similar baseline surgical risk (EuroSCORE 2.25 vs 2.86; p=0.197. Over 12-year study period, there was a significant survival benefit (Hazard Ratio 0.43; [95%Confidence Interval: 0.26-0.72]; p=0.001) with MIMVs+ablation as compared to MIMVS alone. After rigorous propensity matching (LOGIT model, 300 pairs) surgical ablation was associated with nearly 30% improved survival: HR 0.72; (95%CIs: 0.60-0.82); p=0.007. Benefit of surgical ablation was maintained in subgroup analyses, yet most benefit was appraised in low risk patients.ConclusionsConcomitant surgical ablation for atrial fibrillation in patients undergoing minimally invasive mitral valve procedures is safe, feasible and significantly improves late survival. 
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