• Mariusz Kowalewski, Michał Pasierski, Michalina Kołodziejczak, Radosław Litwinowicz, Adam Kowalówka, Wojciech Wańha, Andrzej Łoś, Sebastian Stefaniak, Wojciech Wojakowski, Marek Jemielity, Jan Rogowski, Marek Deja, Krzysztof Bartuś, Silvia Mariani, Tong Li, Matteo Matteucci, Daniele Ronco, Giulio Massimi, Federica Jiritano, Paolo Meani, Giuseppe Maria Raffa, Pietro Giorgio Malvindi, Michał Zembala, Roberto Lorusso, James L Cox, Piotr Suwalski, and Thoracic Research Centre.
• Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland; Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, and Cardiovascular Research Institute Maastricht (CARIM), Maastricht, The Netherlands; Thoracic Research Centre, Collegium Medicum Nicolaus Copernicus University, Innovative Medical Forum, Bydgoszcz, Poland. Electronic address: kowalewskimariusz@gazeta.pl.
• J. Thorac. Cardiovasc. Surg. 2023 Dec 1; 166 (6): 16561668.e81656-1668.e8.

ObjectivePreoperative atrial fibrillation (AF) increases risk of stroke, heart failure, and all-cause mortality after cardiac surgery. Despite encouraging results and guideline recommendations, surgical ablation (SA) for AF concomitant with other heart surgery remains low. In the current study we aimed to address the long-term mortality after SA concomitant with cardiac surgery.MethodsThis report pertains to the HEart surgery In atrial fibrillation and Supraventricular Tachycardia (HEIST) registry. We identified 20,765 adult patients (62% male) with preoperative AF who underwent conventional sternotomy heart surgery between 2010 and 2021 in 8 tertiary centers in Poland, Netherlands, and Italy. We used Cox proportional hazards models for computations and propensity score matching to minimize differences in baseline characteristics.ResultsOf included patients, 2755 (13.4%) underwent SA for AF. The highest rates of SA were observed for mitral interventions (mitral valve repair or replacement and tricuspid intervention, 25.2%), lowest for isolated coronary artery bypass grafting (6.2%). Patients in the SA group were younger (mean age 64.5 ± 9.0 years vs 68.7 ± 16.0 years; P < .001) and lower risk (mean European System for Cardiac Operative Risk Evaluation [EuroSCORE] II, 4.1 vs 5.7; P < .001). During the 11-year study period, there was a mortality reduction associated with SA (hazard ratio, 0.57; 95% CI, 0.52-0.62; P < .001). After propensity matching, 2750 pairs with similar baseline characteristics were identified. SA was associated with 16% mortality decline (hazard ratio, 0.84; 95% CI, 0.75-0.94; P = .003).ConclusionsIn this multicenter, retrospective, propensity matched study, SA concomitant with other cardiac surgery was associated with improved long-term survival regardless of baseline surgical risk.Copyright © 2022 The American Association for Thoracic Surgery. Published by Elsevier Inc. All rights reserved.

22 keywords...

hide…