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Minimally Invasive Surgical Ablation For Atrial Fibrillation Combined With Functional Tricuspid Regurgitation
Ju Mei, Zhaolei Jiang, Chao Wang.
Xinhua Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
BACKGROUND: Clinical outcomes of atrial fibrillation (AF) ablation for AF combined with functional tricuspid regurgitation (FTR) remain inconclusive. Mei Mini Maze Procedure is a minimally invasive surgical technique for treating AF with high success rate. The aim of this study was to evaluate the outcomes of Mei Mini Maze procedure for AF patients with varying severities of FTR.
METHODS: A retrospective analysis was performed for AF patients underwent Mei Mini Maze Procedure between January 2016 and December 2021. Patients were categorized into two groups: significant FTR (moderate or greater severity) and non-significant FTR (mild severity or below). After propensity score matching (PSM), 76 cases were in each group. Changes of FTR severity in each group and differences in postoperatively sinus rhythm (SR) rates based on preoperative FTR severity were analyzed.
RESULTS: Both significant and non-significant FTR patients showed significant improvements in FTR severity, pulmonary artery systolic pressure, tricuspid annular diameter (TAD) and left atrial diameter after surgery (P<0.001). Tricuspid regurgitation jet area decreased significantly in both groups (non-significant group: 3.330 to 0 cm², P<0.001; significant group: 9.055 to 4.335 cm², P<0.001). Significant FTR group had a lower SR maintenance rate (78.95%) compared to non-significant FTR (90.10%) after PSM (P=0.021). Kaplan-Meier analysis revealed that significant FTR patients had a significantly higher risk of AF recurrence during follow-up compared to non-significant FTR (Log-rank P=0.035). Cox regression analysis identified several independent risk factors for AF recurrence during follow-up: FTR remained unimproved(HR=5.547), Non-paroxysmal AF (HR=2.298), AF duration (HR=1.050), Significant FTR (HR=1.054), Tricuspid regurgitation jet area (HR=1.072), Right atrial area (HR=1.134) (P<0.05). For adverse FTR progression events during follow-up, multivariate analysis identified several risk factors: Age > 65 years (HR=3.352), AF duration: (HR=1.066), AF recurrence (HR=14.553), TAD (HR=1.66) (P<0.05).
CONCLUSIONS: The lack of improvement in FTR emerged as a significant risk factor for postoperative AF recurrence, with the risk being particularly pronounced in patients with significant FTR compared to those with non-significant FTR. Addressing correction of tricuspid regurgitation and right atrial ablation concurrently during surgery may contribute to better clinial outcomes for AF patients combined with significant FTR.
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