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Ann Thorac Surg. 2019 Jan;107(1):135-142. doi: 10.1016/j.athoracsur.2018.08.022. Epub 2018 Oct 6.

Surgical Atrial Fibrillation Ablation Improves Long-Term Survival: A Multicenter Analysis.

Author information

1
Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire. Electronic address: alexander.iribarne@hitchcock.org.
2
Department of Surgery, Section of Cardiac Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.
3
Department of Surgery, Section of Cardiac Surgery, Maine Medical Center, Portland, Maine.
4
Department of Surgery, Section of Cardiac Surgery, University of Vermont Medical Center, Burlington, Vermont.
5
Department of Surgery, Section of Cardiac Surgery, Catholic Medical Center, Manchester, New Hampshire.
6
Department of Surgery, Section of Cardiac Surgery, Concord Hospital, Concord, New Hampshire.
7
Department of Surgery, Section of Cardiac Surgery, Eastern Maine Medical Center, Bangor, Maine.
8
Department of Surgery, Section of Cardiac Surgery, Central Maine Medical Center, Lewiston, Maine.
9
Department of Medicine, Section of Cardiology, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire.

Abstract

BACKGROUND:

The Society of Thoracic Surgeons guidelines recommend surgical ablation (SA) at the time of concomitant mitral operations, aortic valve replacement, coronary artery bypass grafting (CABG), and aortic valve replacement plus CABG for patients in atrial fibrillation (AF). The goal of this analysis was to assess the influence of SA on long-term survival.

METHODS:

A retrospective analysis of 20,407 consecutive CABG or valve procedures from 2008 to 2015 among seven centers reporting to a prospectively maintained clinical registry was conducted. Patients undergoing operation with documented preoperative AF were included (n = 2,740). Patients receiving SA were compared with patients receiving no SA. The primary end point was all-cause mortality. Secondary end points included in-hospital morbidity and mortality.

RESULTS:

The frequency of SA was 23.1% (n = 634), and an increase was seen in the rate of SA over the study period (p < 0.001). Concomitant SA was performed in 16.2% of CABG, 30.6% of valve, and 24.3% of valve plus CABG procedures. A substantial improvement was found in unadjusted survival among patients undergoing SA (hazard ratio 0.54, 95% confidence interval: 0.42 to 0.70). Moreover, no differences were found in postoperative complications. SA did have longer bypass times (p < 0.001) but a shorter overall length of stay (p < 0.001). After risk adjustment, SA patients had an improved 5-year survival (hazard ratio 0.69, 95% confidence interval: 0.51 to 0.92), and the effect was observed across all operations.

CONCLUSIONS:

In a multicenter cohort of patients with AF, concomitant SA resulted in substantially improved long-term survival across patients who underwent CABG, valve, and valve plus CABG. These findings support current guidelines from The Society of Thoracic Surgeons that recommend broader application of concomitant SA.

[Indexed for MEDLINE]

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