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Surgical ablation, left atrial appendage occlusion or both? Nationwide registry analysis of cardiac surgery patients with underlying atrial fibrillation.
Pasierski, Michal; Batko, Jakub; Kuzma, Lukasz; Wanha, Wojciech; Jasinski, Marek; Widenka, Kazimierz; Deja, Marek; Bartus, Krzysztof; Hirnle, Tomasz; Wojakowski, Wojciech; Lorusso, Roberto; Tobota, Zdzislaw; Maruszewski, Bohdan J; Suwalski, Piotr; Kowalewski, Mariusz.
Afiliación
  • Pasierski M; Department of Cardiac Surgery and Transplantology, National Medical Institute of the Ministry of Interior and Administration, Warsaw, Poland.
  • Batko J; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
  • Kuzma L; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
  • Wanha W; CAROL-Cardiothoracic Anatomy Research Operative Lab, Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
  • Jasinski M; Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
  • Widenka K; Department of Invasive Cardiology, Medical University of Bialystok, Bialystok, Poland.
  • Deja M; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland.
  • Bartus K; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
  • Hirnle T; Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland.
  • Wojakowski W; Clinical Department of Cardiac Surgery, District Hospital No. 2, Univeristy of Rzeszów, Rzeszów, Poland.
  • Lorusso R; Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland.
  • Tobota Z; Department of Cardiac Surgery, Medical University of Silesia, School of Medicine in Katowice, Katowice, Poland.
  • Maruszewski BJ; Department of Cardiovascular Surgery and Transplantology, Institute of Cardiology, Jagiellonian University Medical College, Krakow, Poland.
  • Suwalski P; Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland.
  • Kowalewski M; Department of Cardiology and Structural Heart Diseases, Medical University of Silesia, Katowice, Poland.
Eur J Cardiothorac Surg ; 65(3)2024 Mar 01.
Article en En | MEDLINE | ID: mdl-38218721
ABSTRACT

OBJECTIVES:

The aim of this study was to evaluate in-hospital outcomes and long-term survival of patients undergoing cardiac surgery with preoperative atrial fibrillation (AF). We compared different strategies, including no-AF treatment, left atrial appendage occlusion (LAAO) alone, concomitant surgical ablation (SA) alone or both.

METHODS:

A retrospective analysis using the KROK registry included all patients with preoperative diagnosis of AF who underwent cardiac surgery in Poland between between January 2012 and December 2022. Risk adjustment was performed using regression analysis with inverse probability weighting of propensity scores. We assessed 6-year survival with Cox proportional hazards models. Sensitivity analysis was performed based on index cardiac procedure.

RESULTS:

Initially, 42 510 patients with preoperative AF were identified, and, after exclusion, 33 949 included in the final analysis. A total of 1107 (3.26%) received both SA and LAAO, 1484 (4.37%) received LAAO alone, 3921 (11.55%) SA alone and the remaining 27 437 (80.82%) had no AF-directed treatment. As compared to no treatment, all strategies were associated with survival benefit over 6-year follow-up. A gradient of treatment was observed with the highest benefit associated with SA + LAAO followed by SA alone and LAAO alone (log-rank P < 0.001). Mortality benefits were reflected when stratified by surgery type with the exception of aortic valve surgery where LAAO alone fare worse than no treatment.

CONCLUSIONS:

Among patients with preoperative AF undergoing cardiac surgery, surgical management of AF, particularly SA + LAAO, was associated with lower 6-year mortality. These findings support the benefits of incorporating SA and LAAO in the management of AF during cardiac surgery.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Apéndice Atrial / Accidente Cerebrovascular / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Eur J Cardiothorac Surg Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Alemania
Texto completo
Añadir a Mi BVS
Imprimir
XML
PubMed Links
Buscar en Google

Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Fibrilación Atrial / Apéndice Atrial / Accidente Cerebrovascular / Procedimientos Quirúrgicos Cardíacos Tipo de estudio: Prognostic_studies Límite: Humans Idioma: En Revista: Eur J Cardiothorac Surg Asunto de la revista: CARDIOLOGIA Año: 2024 Tipo del documento: Article País de afiliación: Polonia Pais de publicación: Alemania