Influence of preoperative atrial fibrillation on late results of mitral repair: is concomitant ablation justified?
Open accessAbstract
Background There is considerable interest in atrial fibrillation (AF) ablation during cardiac operations, but there are few studies addressing the impact of preoperative AF on late outcome of surgery. We therefore investigated AF prevalence in nonrheumatic mitral regurgitation and its effect on late survival and morbidity after repair.Methods From 1993 through 2002, 36% of 2,821 patients with mitral regurgitation had preexisting AF. A cohort of these was matched with controls in sinus rhythm (SR) for age, gender, and ejection fraction. Follow-up was by questionnaire. Outcomes were compared between 231 AF and 229 SR patients, and patients with different types of preoperative AF.Results Patients with preoperative AF were more symptomatic and frequently had cardiomegaly, heart failure, and higher mean pulmonary artery systolic pressure. Operative mortality was higher for AF patients (2% vs 0, p = 0.05). More AF patients had late adverse cardiac events and stroke (63% vs 31%, p < 0.0001). Five- and ten-year survival was, respectively, 95% and 88% for SR patients compared with 90% and 70% (p = 0.01) for the AF group. By multivariate analysis, preoperative AF was not a predictor of long-term survival but was an independent risk factor for late adverse cardiac events and stroke.Conclusions Preoperative AF is a marker for increased surgical risk of mitral regurgitation repair, and a risk factor for late adverse cardiac events and stroke. Although the independent contribution of AF to late survival is uncertain, preoperative AF increases postoperative morbidity independently; therefore, corrective intervention would be expected to benefit patients in this regard.
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AF worsens prognosis in patients with severe valvular heart disease, including those undergoing surgery or transcatheter interventions for aortic or mitral valve disease.
“AF worsens prognosis in patients with severe valvular heart disease, 256 including those undergoing surgery or transcatheter interventions for aortic or mitral valve disease.”
From 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS (2016) · cites this paper as [257]
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2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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Self-citation2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS
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- Authors
- Ngaage, D. L., Schaff, H. V., Mullany, C. J., Barnes, S., Dearani, J. A., Daly, R. C., Orszulak, T. A., & Sundt, T. M.
- Affiliations
- Mayo Clinic (US)
- Venue
- The Annals of Thoracic Surgery
- Publisher
- Elsevier BV
- Published
- 2007-08
- Volume
- 84
- Issue
- 2
- Pages
- 434-443
- ISSN
- 0003-4975 (ISSN-L)
- OpenAlex
- W2040002110
- Cited by
- 118
- References
- 28
- Citations by year
- 2026: 2 · 2025: 4 · 2024: 2 · 2023: 3 · 2022: 6 · 2021: 2 · 2020: 3 · 2019: 3 · 2018: 10 · 2017: 7 · 2016: 6 · 2015: 5 · 2014: 13 · 2013: 6 · 2012: 12
- FWCI
- 6.32
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- The Annals of Thoracic Surgery (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Valve Diseases and Treatments
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Atrial Fibrillation Management and Outcomes
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Cardiac Arrhythmias and Treatments
- Keywords
- preoperative atrial fibrillation, mitral valve surgery, atrial fibrillation ablation, late survival, postoperative morbidity, stroke, postoperative mortality, surgical risk factors
- MeSH terms
- Aged, Atrial Fibrillation, Cause of Death, Female, Follow-Up Studies, Heart Diseases, Heart Rate, Humans, Length of Stay, Male, Middle Aged, Mitral Valve, Mitral Valve Insufficiency, Surveys and Questionnaires, Retrospective Studies, Time Factors, Survival Analysis, Patient Selection
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