Related Experiment Video
Updated: Jul 5, 2025
Cox-Maze IV Procedure Concomitant with Valvular Surgery In Situs Inversus Dextrocardia: A Single-Center Experience in China
Published on: February 11, 2022
Long-term results of atrial fibrillation surgery concomitant with mitral valve surgery: A propensity score-matched
Min-Seok Kim1, Hee Jung Kim2, Hyung Gon Je3
1Cardiovascular Center, Myongji Hospital, Goyang-si, South Korea.
Insights
Concomitant atrial fibrillation surgery with mitral valve surgery improves long-term survival and reduces adverse events in patients with atrial fibrillation and mitral valve disease. This combined approach offers better outcomes compared to mitral valve surgery alone.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation (AF) is a common arrhythmia often associated with mitral valve disease.
- The efficacy of concomitant atrial fibrillation surgery during mitral valve surgery requires long-term outcome evaluation.
Purpose of the Study:
- To compare the long-term outcomes of mitral valve surgery with versus without concomitant atrial fibrillation surgery in patients diagnosed with both conditions.
- To assess the impact of combined surgical approach on mortality, morbidity, and specific adverse events.
Main Methods:
- A retrospective study included 2680 patients undergoing mitral valve surgery between 2005 and 2017.
- Propensity score matching created two groups (n=721 each): one with concomitant atrial fibrillation surgery and one without.
- Outcomes analyzed included all-cause and cardiac mortality, major adverse cardiac and cerebrovascular events (MACCE), stroke/transient ischemic attack (TIA), and permanent pacemaker implantation.
Main Results:
- The atrial fibrillation surgery group demonstrated significantly higher overall survival (91.0% vs. 86.5% at 5 years, P=.013) and cardiac mortality-free survival (96.9% vs. 90.9% at 5 years, P<.001) compared to the non-atrial fibrillation surgery group.
- Cumulative incidence of reoperation, MACCE, and stroke/TIA was lower in the atrial fibrillation surgery group up to 15 years postoperatively (P<.010).
- However, permanent pacemaker implantation was higher in the atrial fibrillation surgery group (P<.001).
Conclusions:
- Concomitant atrial fibrillation surgery during mitral valve surgery is associated with improved long-term survival and reduced adverse cardiac and cerebrovascular events.
- The benefits extend up to 15 years post-surgery, suggesting a favorable risk-benefit profile for the combined procedure.
- While pacemaker implantation rates are higher, the overall reduction in mortality and morbidity supports the consideration of combined surgery for eligible patients.
Objective:
The aim of the study was to elucidate the long-term outcomes of atrial fibrillation surgery in patients with atrial fibrillation and mitral valve disease by comparing the patients who underwent mitral valve surgery with and without atrial fibrillation surgery.
Methods:
Between 2005 and 2017, 2680 patients with atrial fibrillation who underwent mitral valve surgery (mitral valve surgery with atrial fibrillation surgery, n = 1841; mitral valve surgery without atrial fibrillation surgery, n = 839) at 5 centers were included. After propensity score matching, 1442 patients were extracted (atrial fibrillation surgery group, n = 721; non-atrial fibrillation surgery group, n = 721). All-cause mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, stroke or transient ischemic attack, and permanent pacemaker implantation were compared between the atrial fibrillation surgery and non-atrial fibrillation surgery groups.
Results:
Overall survivals at 5 and 10 years postoperatively were 91.0% and 80.7% in the atrial fibrillation surgery group and 86.5% and 75.9% in the non-atrial fibrillation surgery group, respectively (P = .013). Cardiac mortality-free survivals at 5 and 10 years postoperatively were 96.9% and 91.7% in the atrial fibrillation surgery group and 90.9% and 83.7% in the non-atrial fibrillation surgery group, respectively (P < .001). Cumulative incidence of reoperation, major adverse cardiac and cerebrovascular events, and stroke or transient ischemic attack was lower in the matched atrial fibrillation surgery group compared with the matched non-atrial fibrillation surgery group up to 15 years postoperatively (P = .010, P < .001, and P = .012, respectively). Cumulative incidence of permanent pacemaker implantation was higher in the matched atrial fibrillation surgery group compared with the matched non-atrial fibrillation surgery group (P < .001).
Conclusions:
In patients with atrial fibrillation and mitral valve disease, mitral valve surgery concomitant with atrial fibrillation surgery was associated with lower mortality, cardiac mortality, major adverse cardiac and cerebrovascular events, and stroke or transient ischemic attack up to 15 years after surgery when compared with mitral valve surgery without atrial fibrillation surgery.
