Kowalewski Mariusz, Jasiński Marek, Staromłyński Jakub, Zembala Marian, Widenka Kazimierz, Zembala Michał Oskar, Bartuś Krzysztof, Hirnle Tomasz, Dziembowska Inga, Knapik Piotr, Deja Marek, Wierzba Waldemar, Tobota Zdzisław, Maruszewski Bohdan J, Suwalski Piotr
Clinical Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior and Administration, Centre of Postgraduate Medical Education, 02507 Warsaw, Poland.
Department of Cardio-Thoracic Surgery, Heart and Vascular Centre, Maastricht University Medical Centre, 6202 AZ Maastricht, The Netherlands.
J Clin Med. 2020 May 4;9(5):1345. doi: 10.3390/jcm9051345.
The current investigation aimed to evaluate long-term survival in patients undergoing isolated and combined coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were retrospectively collected. Eleven thousand three hundred sixteen patients with baseline AF (72.4% men, mean age 69.6 ± 7.9) undergoing isolated and combined CABG surgery between 2006-2019 in 37 reference centers across Poland and included in the registry were analyzed. The median follow-up was four years (3.7 IQR 1.3-6.8). Over a 12-year study period, there was a significant survival benefit (Hazard Ratio (HR) 0.83; (95% Confidence Interval (CI): 0.73-0.95); = 0.005) with concomitant ablation as compared to no concomitant ablation. After rigorous propensity matching (LOGIT model, 432 pairs), concomitant surgical ablation was associated with over 25% improved survival in the overall analysis: HR 0.74; (95% CIs: 0.56-0.98); = 0.036. The benefit of concomitant ablation was maintained in the subgroups, yet the most benefit was appraised in low-risk patients (EuroSCORE < 2, = 0.003) with the three-vessel disease ( < 0.001) and without other comorbidities. Ablation was further associated with significantly improved survival in patients undergoing CABG with mitral valve surgery (HR 0.62; (95% CIs: 0.52-0.74); < 0.001) and in patients in whom complete revascularization was not achieved: HR 0.43; (95% CIs: 0.24-0.79); = 0.006.
本研究旨在评估接受单纯及联合冠状动脉旁路移植术（CABG）并同期行房颤（AF）手术消融患者的长期生存率。回顾性收集了来自KROK（波兰国家心脏外科手术登记处）的手术数据。对2006年至2019年期间在波兰37个参考中心接受单纯及联合CABG手术且基线为房颤的11316例患者（72.4%为男性，平均年龄69.6±7.9岁）进行分析，这些患者均被纳入该登记处。中位随访时间为4年（四分位间距3.7，1.3 - 6.8）。在12年的研究期内，与未同期消融相比，同期消融具有显著的生存获益（风险比（HR）0.83；95%置信区间（CI）：0.73 - 0.95；P = 0.005）。经过严格的倾向评分匹配（LOGIT模型，432对）后，在总体分析中，同期手术消融与生存率提高超过25%相关：HR 0.74；（95% CI：0.56 - 0.98）；P = 0.036。同期消融的益处在亚组中得以维持，但在低风险患者（欧洲心脏手术风险评估系统（EuroSCORE）<2，P = 0.003）、三支血管病变患者（P < 0.001）且无其他合并症的患者中获益最大。消融还与接受CABG并同期行二尖瓣手术患者的生存率显著提高相关（HR 0.62；（95% CI：0.52 - 0.74）；P < 0.001），以及与未实现完全血运重建的患者生存率显著提高相关：HR 0.43；（95% CI：0.24 - 0.79）；P = 0.006。
