Department of Cardiac, Thoracic, Vascular Sciences and Public Health, Cardiac Surgery Unit, University of Padua, Padua, Italy.
Department of Cardiothoracic Surgery, University of Louisville, Louisville, Kentucky.
Am J Cardiol. 2023 Dec 15;209:104-113. doi: 10.1016/j.amjcard.2023.09.088. Epub 2023 Oct 14.
Although surgical ablation has been shown to produce excellent outcomes at follow-up for patients with atrial fibrillation who underwent mitral valve replacement/repair (MVR), this procedure is not commonly performed. Our objective was to conduct a systematic review and meta-analysis to evaluate the outcomes of concomitant surgical ablation during MVR. Three databases were systematically reviewed for randomized clinical trials published by August 2022. The primary outcome was sinus rhythm (SR) at 12 months. Secondary outcomes included SR at discharge and 6 months, all-cause mortality, permanent pacemaker implantation, and stroke and thromboembolic events. A random-effects meta-analysis was performed, calculating odds ratios (ORs) for each outcome. Thirteen studies were included, involving 1,089 patients comparing patients who underwent either isolated MVR ("MVR-only") or concomitant surgical ablation during MVR ("MVR+Ablation"). The odds of SR were significantly higher in the MVR+Ablation group at discharge (OR 9.62, 95% confidence interval [CI] 4.87 to 19.02, I = 55%), at 6-month follow-up (OR 7.21, 95% CI 4.30 to 12.11, I = 34%), and at 1-year follow-up (OR 8.41, 95% CI 5.14 to 13.77, I = 48%). All-cause mortality was not different in the groups, as were stroke and thromboembolic events, whereas the odds of permanent pacemaker implantation were slightly higher in the MVR+Ablation group (OR 1.87, 95% CI 1.11 to 3.17, I = 0%). Concomitant surgical ablation during MVR showed excellent outcomes at short-term follow-up, despite a slightly higher rate of permanent pacemaker implantation. Further studies with longer follow-ups are needed to assess if the SR is maintained over the years.
尽管对于接受二尖瓣置换/修复（MVR）的房颤患者，手术消融在随访时表现出优异的效果，但该手术并不常见。我们的目的是进行系统评价和荟萃分析，以评估 MVR 时同期手术消融的结果。系统检索了截至 2022 年 8 月发表的随机临床试验的三个数据库。主要结局是 12 个月时窦性心律（SR）。次要结局包括出院时和 6 个月时的 SR、全因死亡率、永久性起搏器植入以及卒中和血栓栓塞事件。进行了随机效应荟萃分析，计算了每个结局的优势比（OR）。纳入了 13 项研究，共涉及 1089 名患者，比较了接受单纯 MVR（“MVR 仅”）或 MVR 时同期手术消融（“MVR+消融”）的患者。MVR+消融组在出院时（OR 9.62，95%置信区间 [CI] 4.87 至 19.02，I = 55%）、6 个月随访时（OR 7.21，95% CI 4.30 至 12.11，I = 34%）和 1 年随访时（OR 8.41，95% CI 5.14 至 13.77，I = 48%）SR 的可能性显著更高。两组的全因死亡率无差异，卒中及血栓栓塞事件也无差异，而 MVR+消融组永久性起搏器植入的可能性略高（OR 1.87，95% CI 1.11 至 3.17，I = 0%）。尽管永久性起搏器植入率略高，但 MVR 时同期手术消融在短期随访中显示出良好的效果。需要进一步进行随访时间更长的研究，以评估 SR 是否能维持多年。
