Pregaldini Fabio, Çelik Mevlüt, Mosbahi Selim, Barmettler Stefania, Praz Fabien, Reineke David, Siepe Matthias, Pingpoh Clarence
Department of Cardiac Surgery, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Department of Cardiology, Inselspital, Bern University Hospital, University of Bern, Bern, Switzerland.
Interdiscip Cardiovasc Thorac Surg. 2024 Aug 1;39(2). doi: 10.1093/icvts/ivae144.
We retrospectively analysed perioperative and mid-term outcomes for patients undergoing mitral valve surgery with and without atrial fibrillation.
Patients who underwent mitral valve surgery between January 2018 and February 2023 were included and categorized into 3 groups: 'No AF' (no documented atrial fibrillation), 'AF no SA' (atrial fibrillation without surgical ablation) and 'AF and SA' (atrial fibrillation with concomitant surgical ablation). Groups were compared for perioperative and mid-term outcomes, including mortality, stroke, bleeding and pacemaker implantation. A P-value <0.05 was considered statistically significant.
Of the 400 patients included, preoperative atrial fibrillation was present in 43%. Mean follow-up was 1.8 (standard deviation: 1.1) years. The patients who underwent surgical ablation for atrial fibrillation exhibited similar overall outcomes compared to patients without preoperative atrial fibrillation. Patients with untreated atrial fibrillation showed higher mortality ('No AF': 2.2% versus 'AF no SA': 8.3% versus 'AF and SA': 3.2%; P-value 0.027) and increased postoperative pacemaker implantation rates ('No AF': 5.7% versus 'AF no SA': 15.6% versus 'AF and SA': 7.9%, P-value: 0.011). In a composite analysis of adverse events (Mortality, Bleeding, Stroke), the highest incidence was observed in patients with untreated atrial fibrillation, while patients with treated atrial fibrillation had similar outcomes as those without preoperative documented atrial fibrillation ('No AF': 9.6% versus 'AF no SA': 20.2% versus 'AF and SA' 3: 9.5%, P-value: 0.018).
Concomitant surgical ablation should be considered in mitral valve surgery for atrial fibrillation, as it leads to similar mid-term outcomes compared to patients without preoperative documented atrial fibrillation.
我们回顾性分析了接受二尖瓣手术且伴有或不伴有心房颤动患者的围手术期和中期结局。
纳入2018年1月至2023年2月期间接受二尖瓣手术的患者，并将其分为3组：“无房颤”（无记录的心房颤动）、“房颤无手术消融”（有心房颤动但未进行手术消融）和“房颤伴手术消融”（有心房颤动且同时进行手术消融）。比较各组的围手术期和中期结局，包括死亡率、中风、出血和起搏器植入情况。P值<0.05被认为具有统计学意义。
在纳入的400例患者中，43%存在术前心房颤动。平均随访时间为1.8（标准差：1.1）年。与无术前心房颤动的患者相比，接受心房颤动手术消融的患者总体结局相似。未治疗心房颤动的患者死亡率更高（“无房颤”：2.2%，“房颤无手术消融”：8.3%，“房颤伴手术消融”：3.2%；P值0.027），术后起搏器植入率增加（“无房颤”：5.7%，“房颤无手术消融”：15.6%，“房颤伴手术消融”：7.9%，P值：0.011）。在不良事件（死亡率、出血、中风）的综合分析中，未治疗心房颤动的患者不良事件发生率最高，而接受治疗心房颤动的患者结局与无术前记录心房颤动的患者相似（“无房颤”：9.6%，“房颤无手术消融”：20.2%，“房颤伴手术消融”：9.5%，P值：0.018）。
二尖瓣手术治疗心房颤动时应考虑同时进行手术消融，因为与无术前记录心房颤动的患者相比，其中期结局相似。
