Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Surgical Ablation of Atrial Fibrillation in Patients Undergoing Bioprosthetic Valve Replacement

  • Pyo, WonKyung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Park, Sung Jun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Wan Kee (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Ho Jin (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Kim, Joon Bum (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Jung, Sung-Ho (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Joo, Suk Jung (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Chung, Cheol Hyun (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine) ;
  • Lee, Jae Won (Department of Thoracic and Cardiovascular Surgery, Asan Medical Center, University of Ulsan College of Medicine)
  • Received : 2018.09.07
  • Accepted : 2018.11.01
  • Published : 2019.04.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Scarce data have been reported on the efficacy of concomitant atrial fibrillation (AF) ablation in patients undergoing bioprosthetic valve replacement. Methods: From 2001 and 2014, 146 consecutive patients ($69.3{\pm}9.4years$, 84 females) who underwent bioprosthetic heart valve replacement concomitant with AF ablation were assessed. We evaluated long-term rhythm and valve-related outcomes. Results: During 49.1 months of follow-up (interquartile range, 22.5-96.8 months), 7 in-hospital and 49 (6.7% per person-year) post-discharge deaths occurred. The thromboembolic event-free survival rate at 5 years was $79.2%{\pm}3.5%$. The freedom from AF recurrence rate at 5 years was $59.8%{\pm}4.9%$. Multivariate analysis showed that old age (hazard ratio [HR], 1.06; 95% confidence interval [CI], 1.02-1.11; p=0.002), previous cardiac operation (HR, 3.01; 95% CI, 1.22-7.43; p=0.02), and a large left atrial (LA) dimension (HR, 1.02; 95% CI, 1.00-1.05; p=0.045) were significantly associated with AF recurrence. Conclusion: The overall long-term clinical outcomes in these predominantly elderly patients undergoing AF ablation concomitantly with bioprosthetic valve replacement were satisfactory; however, AF recurrence was frequent. Older age, a history of prior cardiac surgery, and large LA size were associated with an increased risk of AF recurrence.

Keywords

References

  1. Haissaguerre M, Jais P, Shah DC, et al. Spontaneous initiation of atrial fibrillation by ectopic beats originating in the pulmonary veins. N Engl J Med 1998;339:659-66. https://doi.org/10.1056/NEJM199809033391003
  2. Marrouche NF, Dresing T, Cole C, et al. Circular mapping and ablation of the pulmonary vein for treatment of atrial fibrillation: impact of different catheter technologies. J Am Coll Cardiol 2002;40:464-74. https://doi.org/10.1016/S0735-1097(02)01972-1
  3. Pappone C, Rosanio S, Augello G, et al. Mortality, morbidity, and quality of life after circumferential pulmonary vein ablation for atrial fibrillation: outcomes from a controlled nonrandomized long-term study. J Am Coll Cardiol 2003;42:185-97. https://doi.org/10.1016/S0735-1097(03)00577-1
  4. Saint LL, Damiano RJ Jr, Cuculich PS, et al. Incremental risk of the Cox-maze IV procedure for patients with atrial fibrillation undergoing mitral valve surgery. J Thorac Cardiovasc Surg 2013;146:1072-7. https://doi.org/10.1016/j.jtcvs.2013.06.048
  5. Doukas G, Samani NJ, Alexiou C, et al. Left atrial radiofrequency ablation during mitral valve surgery for continuous atrial fibrillation: a randomized controlled trial. JAMA 2005;294:2323-9. https://doi.org/10.1001/jama.294.18.2323
  6. Lee SH, Kim JB, Cho WC, et al. The influence of age on atrial fibrillation recurrence after the maze procedure in patients with giant left atrium. J Thorac Cardiovasc Surg 2011;141:1015-9. https://doi.org/10.1016/j.jtcvs.2010.08.036
  7. Kim JB, Yun TJ, Chung CH, Choo SJ, Song H, Lee JW. Long-term outcome of modified maze procedure combined with mitral valve surgery: analysis of outcomes according to type of mitral valve surgery. J Thorac Cardiovasc Surg 2010;139:111-7. https://doi.org/10.1016/j.jtcvs.2009.07.002
  8. Kim JB, Moon JS, Yun SC, et al. Long-term outcomes of mechanical valve replacement in patients with atrial fibrillation: impact of the maze procedure. Circulation 2012;125:2071-80. https://doi.org/10.1161/CIRCULATIONAHA.111.082347
  9. Kim JB, Bang JH, Jung SH, Choo SJ, Chung CH, Lee JW. Left atrial ablation versus biatrial ablation in the surgical treatment of atrial fibrillation. Ann Thorac Surg 2011;92:1397-404. https://doi.org/10.1016/j.athoracsur.2011.05.066
  10. Akins CW, Miller DC, Turina MI, et al. Guidelines for reporting mortality and morbidity after cardiac valve interventions. Eur J Cardiothorac Surg 2008;33:523-8. https://doi.org/10.1016/j.ejcts.2007.12.055
  11. Gillinov AM, Sirak J, Blackstone EH, et al. The Cox maze procedure in mitral valve disease: predictors of recurrent atrial fibrillation. J Thorac Cardiovasc Surg 2005;130:1653-60. https://doi.org/10.1016/j.jtcvs.2005.07.028
  12. Bando K, Kasegawa H, Okada Y, et al. Impact of preoperative and postoperative atrial fibrillation on outcome after mitral valvuloplasty for nonischemic mitral regurgitation. J Thorac Cardiovasc Surg 2005;129:1032-40. https://doi.org/10.1016/j.jtcvs.2004.10.037
  13. Bando K, Kobayashi J, Kosakai Y, et al. Impact of Cox maze procedure on outcome in patients with atrial fibrillation and mitral valve disease. J Thorac Cardiovasc Surg 2002;124:575-83. https://doi.org/10.1067/mtc.2002.124392

Cited by

  1. Оperation «labyrinth» in surgical treatment of combined mitral-аоrtic failures vol.87, pp.7, 2019, https://doi.org/10.26779/2522-1396.2020.7-8.25
  2. Effectiveness of the Early Staged Hybrid Approach for Treatment of Symptomatic Atrial Fibrillation: the Electrophysiology Study Could Be Deferred? vol.36, pp.43, 2019, https://doi.org/10.3346/jkms.2021.36.e276