Impact of concomitant surgical atrial fibrillation ablation in patients undergoing aortic valve replacement

Jae Suk Yoo, Joon Bum Kim, Sun Kyun Ro, Yoonsuh Jung, Sung Ho Jung, Suk Jung Choo, Jae Won Lee, Cheol Hyun Chung

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Background: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain. Methods and Results: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9-47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56-2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4 mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001). Conclusions: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.

Original languageEnglish
Pages (from-to)1364-1371
Number of pages8
JournalCirculation Journal
Volume78
Issue number6
DOIs
Publication statusPublished - 2014 Jan 1
Externally publishedYes

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Aortic Valve
Atrial Fibrillation
Disease-Free Survival
Confidence Intervals
Morbidity
Mortality

Keywords

  • Aortic valve replacement
  • Atrial fibrillation
  • Maze procedure

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Impact of concomitant surgical atrial fibrillation ablation in patients undergoing aortic valve replacement. / Yoo, Jae Suk; Kim, Joon Bum; Ro, Sun Kyun; Jung, Yoonsuh; Jung, Sung Ho; Choo, Suk Jung; Lee, Jae Won; Chung, Cheol Hyun.

In: Circulation Journal, Vol. 78, No. 6, 01.01.2014, p. 1364-1371.

Research output: Contribution to journalArticle

Yoo, Jae Suk ; Kim, Joon Bum ; Ro, Sun Kyun ; Jung, Yoonsuh ; Jung, Sung Ho ; Choo, Suk Jung ; Lee, Jae Won ; Chung, Cheol Hyun. / Impact of concomitant surgical atrial fibrillation ablation in patients undergoing aortic valve replacement. In: Circulation Journal. 2014 ; Vol. 78, No. 6. pp. 1364-1371.
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AU - Kim, Joon Bum

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AU - Choo, Suk Jung

AU - Lee, Jae Won

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N2 - Background: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain. Methods and Results: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9-47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56-2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4 mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001). Conclusions: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.

AB - Background: The clinical benefit of concomitant atrial fibrillation (AF) ablation at the time of aortic valve replacement (AVR) is uncertain. Methods and Results: A total of 124 patients with AF who underwent AVR with (n=50) or without (n=74) a concomitant maze procedure, between 2000 and 2011, were evaluated. There were no significant differences in early postoperative outcomes. During a median clinical follow-up of 18.1 months (interquartile range: 6.9-47.8 months), 19 late deaths (15.3%) and 33 valve-related complications (26.6%) occurred, but the differences between groups were not statistically significant. Major event-free survival at 5 years was 60.9±9.9% vs. 57.0±10.3% (P=0.41). After adjustment, the maze group demonstrated similar risks for major adverse cardiac events (hazard ratio, 1.18; 95% confidence interval, 0.56-2.49; P=0.67). However, the rate of sinus rhythm restoration at 4 years was significantly higher in the maze group (80.6% vs. 3.6%, P<0.001). Left atrial dimension was smaller (46.9 vs. 50.4 mm, P=0.017), and the ejection fraction was higher (60.6% vs. 58.0%, P=0.059) in the maze group. The rate of postoperative anticoagulation was also lower in the maze group (53.1% vs. 89.2%, P<0.001). Conclusions: Concomitant AF ablation in patients undergoing AVR resulted in increased sinus rhythm restoration, better echocardiographic results, and decreased anticoagulation requirement, without increasing surgical morbidity or mortality.

KW - Aortic valve replacement

KW - Atrial fibrillation

KW - Maze procedure

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