Associations Between Surgical Ablation and Operative Mortality Following Mitral Valve Procedures.

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Citation: Annals of Thoracic Surgery. 105(6):1790-1796, 2018 06.PMID: 29391145Institution: MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atrial Fibrillation/su [Surgery] | *Catheter Ablation/mo [Mortality] | *Heart Valve Prosthesis Implantation/mo [Mortality] | *Hospital Mortality/td [Trends] | *Mitral Valve Insufficiency/su [Surgery] | Aged | Atrial Fibrillation/mo [Mortality] | Catheter Ablation/mt [Methods] | Cause of Death | Combined Modality Therapy | Female | Follow-Up Studies | Heart Valve Prosthesis Implantation/mt [Methods] | Humans | Logistic Models | Male | Middle Aged | Multivariate Analysis | Retrospective Studies | Risk Assessment | Survival Analysis | Treatment OutcomeYear: 2018Local holdings: Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007ISSN:
  • 0003-4975
Name of journal: The Annals of thoracic surgeryAbstract: BACKGROUND: Surgical ablation (SA) for atrial fibrillation (AF) concomitant to mitral valve repair/replacement (MVRR) improves longitudinal sinus rhythm. However, the risk of adding SA remains a clinical question. This study examined whether the addition of contemporary SA for AF has an impact on operative outcomes.CONCLUSIONS: For patients with AF at the time of mitral surgery, the performance of SA seems associated with a lower risk-adjusted operative mortality compared to patients who are not ablated.Copyright (c) 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.METHODS: The study cohort included 88,765 MVRR patients +/- SA, CABG, septal defect, and tricuspid repair in the STS Database between 2011 and 2014. Group 1 did not have AF (No-AF) and did not receive SA (No-SA); Group 2 had No-AF immediately preoperatively but received SA; Group 3 had AF but No-SA; and Group 4 had AF with SA. Groups 3 and 4 were stratified into paroxysmal versus non-paroxysmal AF. Using logistic regression, with Group 1 as reference, risk-adjusted odds ratios (OR) for mortality were compared for SA performance, AF type, and SA technique.RESULTS: Group 3 had higher age, NYHA Class, redo operations, and unadjusted mortality than Group 4. Relative to Group 1, Group 3 had an OR for mortality of 1.15 (1.04-1.27;p<0.01). OR increments were similar for paroxysmal and non-paroxysmal AF. In Group 4, concomitant SA was independently associated with lower AF-related relative risk (OR=1.08), to a level that was not different from Group 1 (p=0.13). Observed treatment effects were equivalent for paroxysmal and non-paroxysmal AF, and across all levels of baseline risk.All authors: Ad N, Badhwar V, Brennan JM, Damiano RJ Jr., Gillinov AM, Grau-Sepulveda MV, Jacobs JP, McCarthy PM, Rankin JS, Shahian DM, Thourani VHFiscal year: FY2018Digital Object Identifier: Date added to catalog: 2018-02-20
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Item type Current library Collection Call number Status Date due Barcode
Journal Article MedStar Authors Catalog Article 29391145 Available 29391145

Available online from MWHC library: 1995 - present, Available in print through MWHC library:1999-2007

BACKGROUND: Surgical ablation (SA) for atrial fibrillation (AF) concomitant to mitral valve repair/replacement (MVRR) improves longitudinal sinus rhythm. However, the risk of adding SA remains a clinical question. This study examined whether the addition of contemporary SA for AF has an impact on operative outcomes.

CONCLUSIONS: For patients with AF at the time of mitral surgery, the performance of SA seems associated with a lower risk-adjusted operative mortality compared to patients who are not ablated.

Copyright (c) 2018 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

METHODS: The study cohort included 88,765 MVRR patients +/- SA, CABG, septal defect, and tricuspid repair in the STS Database between 2011 and 2014. Group 1 did not have AF (No-AF) and did not receive SA (No-SA); Group 2 had No-AF immediately preoperatively but received SA; Group 3 had AF but No-SA; and Group 4 had AF with SA. Groups 3 and 4 were stratified into paroxysmal versus non-paroxysmal AF. Using logistic regression, with Group 1 as reference, risk-adjusted odds ratios (OR) for mortality were compared for SA performance, AF type, and SA technique.

RESULTS: Group 3 had higher age, NYHA Class, redo operations, and unadjusted mortality than Group 4. Relative to Group 1, Group 3 had an OR for mortality of 1.15 (1.04-1.27;p<0.01). OR increments were similar for paroxysmal and non-paroxysmal AF. In Group 4, concomitant SA was independently associated with lower AF-related relative risk (OR=1.08), to a level that was not different from Group 1 (p=0.13). Observed treatment effects were equivalent for paroxysmal and non-paroxysmal AF, and across all levels of baseline risk.

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