Division of Thoracic and Cardiovascular Surgery, Department of Surgery, Chang Gung Memorial Hospital, Linkou Medical Center, Chang Gung University, Taoyuan City, Taiwan.
Center for Big Data Analytics and Statistics, Chang Gung Memorial Hospital, Linkou Medical Center, Taoyuan City, Taiwan.
Ann Thorac Surg. 2023 Aug;116(2):297-305. doi: 10.1016/j.athoracsur.2022.09.036. Epub 2022 Oct 7.
The long-term outcomes of surgical ablation for atrial fibrillation (AF) during cardiac surgery remain unclear.
This nationwide population-based retrospective cohort study used data from Taiwan's National Health Insurance Research Database. Overall, 11,459 patients undergoing coronary artery bypass graft, valve, or aortic surgery and diagnosed as having AF between January 1, 2001, and December 31, 2016, were included. To reduce possible selection bias, we created a propensity score-matched cohort and compared outcomes between groups. The outcomes of interest were long-term survival and late ischemic stroke.
The surgical ablation group had a significantly lower risk of all-cause mortality (5.74 and 7.69 events per 100 patient-years, respectively; hazard ratio, 0.75; 95% CI, 0.69-0.81) and ischemic stroke after discharge (1.88 and 2.52 events per 100 patient-years, respectively; subdistribution hazard ratio, 0.78; 95% CI, 0.67-0.91). AF ablation performed concomitantly with coronary artery bypass graft surgery, tissue aortic valve replacement, tissue mitral valve replacement, or mitral valve repair led to significantly better long-term survival (P = .0176, P = .0001, P < .0001, P < .0001, respectively). The surgical ablation group also had better long-term survival than the matched general AF population (log-rank test, P < .001).
Concomitant AF ablation during cardiac surgery is safe, does not increase the rate of perioperative complications, and confers the benefit of long-term survival after cardiac surgery in adults. AF ablation also improved cardiac surgery patients' long-term survival compared with the matched general AF population.
心脏手术中房颤（AF）的外科消融的长期结果仍不清楚。
这是一项全国范围内基于人群的回顾性队列研究，使用了来自台湾全民健康保险研究数据库的数据。共有 11459 例在 2001 年 1 月 1 日至 2016 年 12 月 31 日期间接受冠状动脉旁路移植、瓣膜或主动脉手术并被诊断为 AF 的患者被纳入研究。为了减少可能的选择偏倚，我们创建了一个倾向评分匹配队列，并比较了两组的结果。感兴趣的结果是长期生存和晚期缺血性卒中。
外科消融组的全因死亡率风险显著降低（分别为每 100 患者年 5.74 和 7.69 例事件；风险比，0.75；95%置信区间，0.69-0.81），出院后缺血性卒中的风险也降低（分别为每 100 患者年 1.88 和 2.52 例事件；亚分布风险比，0.78；95%置信区间，0.67-0.91）。AF 消融与冠状动脉旁路移植术、组织主动脉瓣置换术、组织二尖瓣置换术或二尖瓣修复术同时进行可显著提高长期生存率（P=0.0176，P=0.0001，P<0.0001，P<0.0001，分别）。与匹配的一般 AF 人群相比，外科消融组也有更好的长期生存率（对数秩检验，P<0.001）。
心脏手术中同时进行 AF 消融是安全的，不会增加围手术期并发症的发生率，并为成人心脏手术后带来长期生存的获益。与匹配的一般 AF 人群相比，AF 消融也改善了心脏手术患者的长期生存。
