Concomitant atrial fibrillation ablation during aortic valve and aneurysm surgery

Limited data are available on treatment of atrial fibrillation during ascending aortic aneurysm and aortic valve surgery. Ablation at the time of isolated aortic valve surgery has a Society of Thoracic Surgeons Class I indication. We sought to determine early and late outcomes of concomitant atrial fibrillation surgery at the time of ascending aortic aneurysm + aortic valve surgery.

From July 2008 to June 2023, patients undergoing elective ascending aortic aneurysm + aortic valve surgery ± atrial fibrillation surgery were compared. Clinical follow-up was conducted annually (median 5.6 [3.1-9.2] years).

Of 792 patients in the cohort, 89 (11.2%) had preoperative atrial fibrillation and all underwent atrial fibrillation ablation procedures: pulmonary vein isolation (42.7%), left atrial cryoablation (19.1%), and biatrial cryoablation (38.2%). After 2:1 propensity score matching between the no atrial fibrillation (123) and ablation groups (67), postoperative complications were pacemaker implant (1.7% vs 1.6%; P = .952), new-onset dialysis (0.8% vs 3.0%, P = .251), and 30-day mortality (0.8% vs 1.5%, P = .661). In matched patients with no atrial fibrillation and atrial fibrillation surgery, overall survival at 1, 5, and 10 years was similar (P = .4) at a mean of 6.22 years follow-up. Stroke incidence was similar at 7.8% versus 3.3% (P = .236).

For patients undergoing aneurysm surgery concomitantly with aortic valve surgery, surgical ablation was effective and did not increase 30-day mortality. Survival and stroke outcomes were similar to a matched reference group without preoperative atrial fibrillation. Ablation of atrial fibrillation should be considered at the time of aortic surgery.