Outcomes In Minimally-invasive Mitral Valve Surgery With Concomitant Surgical Af Ablation
Johannes Petersen, Evaldas Girdauskas, Hermann Reichenspurner, Simon Pecha.
University Heart and Vascular Center Hamburg, Hamburg, Germany.
Background: Minimally-invasive access is the standard approach for mitral valve surgery in specialized heart centers. Further, concomitant surgical ablation is an established procedure for patients with atrial fibrillation (AF) undergoing cardiac surgery which can be also performed in the minimally-invasive setting. We therefore analyzed the safety and efficacy of surgical AF ablation in minimally-invasive mitral valve surgery.
Methods: Between 01/2003 and 07/2017 1003 patients underwent concomitant surgical AF ablation in our institution. 96 patients received minimally invasive mitral valve surgery with concomitant AF ablation and served as our primary study cohort. Rhythm monitoring was performed by 24h-Holter ECG at 3 and 12 months. Primary endpoint of the study was freedom from AF at 12 months follow-up.
Results:Mean age of the studied cohort was 62.2 ± 10.5 years, 58.2% were male and the mean duration of AF was 23.6 months. 54.2% of patients had persistent or long-standing persistent AF. Concomitant tricuspid valve repair was performed in 11.3 % of the patients. Cryoablation was used in 36 % and radiofrequency in 64 % of the patients. Primary, left atrial ablation was done via the minimally invasive access (87 %), while the remaining 13% received a biatrial ablation. In addition, 70.8% of the patients received a left atrial appendage (LAA) closure. There were no ablation-related complications and no perioperative death. Permanent pacemaker implantation rate during follow-up was 6.4%. Freedom from AF at 12 months was 66.7 %, with a trend towards higher success rate in patients with paroxysmal AF (76% vs. 56%; p = 0.057).
Conclusions: Surgical AF ablation in minimally-invasive mitral valve surgery is safe and feasible, even with additional procedures (e.g. LAA closure, tricuspid valve repair) resulting in good and comparable rates of freedom from AF at 12 months. In our institution, cryoablation and LAA closure with Atriclip has become the standard approach for minimally-invasive mitral valve surgery in patients with atrial fibrillation.
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