Comparison of early outcomes of surgical ablation procedures for atrial fibrillation concomitant to non-mitral cardiac surgery

a Japan Adult Cardiovascular Surgery Database study

Hideaki Takai, Hiroaki Miyata, Noboru Motomura, Kenichi Sasaki, Takashi Kunihara, Shinichi Takamoto

Research output: Contribution to journalArticle

1 Citation (Scopus)

Abstract

Objective: Although the benefit of surgical ablation for atrial fibrillation (AF) performed concomitant to mitral valve surgery is established, whether that performed concomitant to non-mitral cardiac surgery is beneficial remains unclear. In non-mitral, non-left-atriotomy cardiac surgery, the optimal surgical approach for AF remains to be established. Therefore, using the Japan Adult Cardiovascular Surgery Database (JACVSD), we compared 2 surgical ablation procedures [the maze procedure and pulmonary vein isolation (PVI)] performed concomitant to non-mitral cardiac surgery. Methods: Of 3402 JACVSD patients who had undergone elective non-mitral cardiac surgery by 2012, 1797 (53%) had undergone concomitant PVI, and 1339 (39%) had undergone the maze procedure. To compensate for patient heterogeneity, we conducted a propensity score-matched analysis of 1952 patients who had undergone PVI or the maze procedure (976 patients each). Results: Operative procedures took significantly longer in the Maze Group. Although postoperative AF occurred in 34.3% of the PVI Group patients and in 31.9% of the Maze Group patients (p = 0.371), the incidence of first-time pacemaker implantation was significantly lower in the PVI Group (1.9 vs. 4.1%, respectively; p = 0.005). There was no significant difference in other morbidities or in operative mortality. Postoperative hospital and ICU stays tended to be longer in the Maze Group. Conclusions: Our data indicate that surgical ablation of AF concomitant to non-mitral cardiac surgery is beneficial. Furthermore, PVI and the maze procedure appear to be of equal benefit in this context, except that the maze procedure may more frequently result in the need for pacemaker implantation.

Original languageEnglish
Pages (from-to)1-6
Number of pages6
JournalGeneral Thoracic and Cardiovascular Surgery
DOIs
Publication statusAccepted/In press - 2017 May 23
Externally publishedYes

Fingerprint

Pulmonary Veins
Atrial Fibrillation
Thoracic Surgery
Japan
Databases
Patient Isolation
Propensity Score
Operative Surgical Procedures
Mitral Valve
Length of Stay
Morbidity
Mortality
Incidence

Keywords

  • Atrial fibrillation
  • Maze procedure
  • Non-mitral cardiac surgery
  • Pulmonary vein isolation
  • Surgical ablation

ASJC Scopus subject areas

  • Surgery
  • Pulmonary and Respiratory Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Comparison of early outcomes of surgical ablation procedures for atrial fibrillation concomitant to non-mitral cardiac surgery : a Japan Adult Cardiovascular Surgery Database study. / Takai, Hideaki; Miyata, Hiroaki; Motomura, Noboru; Sasaki, Kenichi; Kunihara, Takashi; Takamoto, Shinichi.

In: General Thoracic and Cardiovascular Surgery, 23.05.2017, p. 1-6.

Research output: Contribution to journalArticle

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title = "Comparison of early outcomes of surgical ablation procedures for atrial fibrillation concomitant to non-mitral cardiac surgery: a Japan Adult Cardiovascular Surgery Database study",
abstract = "Objective: Although the benefit of surgical ablation for atrial fibrillation (AF) performed concomitant to mitral valve surgery is established, whether that performed concomitant to non-mitral cardiac surgery is beneficial remains unclear. In non-mitral, non-left-atriotomy cardiac surgery, the optimal surgical approach for AF remains to be established. Therefore, using the Japan Adult Cardiovascular Surgery Database (JACVSD), we compared 2 surgical ablation procedures [the maze procedure and pulmonary vein isolation (PVI)] performed concomitant to non-mitral cardiac surgery. Methods: Of 3402 JACVSD patients who had undergone elective non-mitral cardiac surgery by 2012, 1797 (53{\%}) had undergone concomitant PVI, and 1339 (39{\%}) had undergone the maze procedure. To compensate for patient heterogeneity, we conducted a propensity score-matched analysis of 1952 patients who had undergone PVI or the maze procedure (976 patients each). Results: Operative procedures took significantly longer in the Maze Group. Although postoperative AF occurred in 34.3{\%} of the PVI Group patients and in 31.9{\%} of the Maze Group patients (p = 0.371), the incidence of first-time pacemaker implantation was significantly lower in the PVI Group (1.9 vs. 4.1{\%}, respectively; p = 0.005). There was no significant difference in other morbidities or in operative mortality. Postoperative hospital and ICU stays tended to be longer in the Maze Group. Conclusions: Our data indicate that surgical ablation of AF concomitant to non-mitral cardiac surgery is beneficial. Furthermore, PVI and the maze procedure appear to be of equal benefit in this context, except that the maze procedure may more frequently result in the need for pacemaker implantation.",
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T1 - Comparison of early outcomes of surgical ablation procedures for atrial fibrillation concomitant to non-mitral cardiac surgery

T2 - a Japan Adult Cardiovascular Surgery Database study

AU - Takai, Hideaki

AU - Miyata, Hiroaki

AU - Motomura, Noboru

AU - Sasaki, Kenichi

AU - Kunihara, Takashi

AU - Takamoto, Shinichi

PY - 2017/5/23

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N2 - Objective: Although the benefit of surgical ablation for atrial fibrillation (AF) performed concomitant to mitral valve surgery is established, whether that performed concomitant to non-mitral cardiac surgery is beneficial remains unclear. In non-mitral, non-left-atriotomy cardiac surgery, the optimal surgical approach for AF remains to be established. Therefore, using the Japan Adult Cardiovascular Surgery Database (JACVSD), we compared 2 surgical ablation procedures [the maze procedure and pulmonary vein isolation (PVI)] performed concomitant to non-mitral cardiac surgery. Methods: Of 3402 JACVSD patients who had undergone elective non-mitral cardiac surgery by 2012, 1797 (53%) had undergone concomitant PVI, and 1339 (39%) had undergone the maze procedure. To compensate for patient heterogeneity, we conducted a propensity score-matched analysis of 1952 patients who had undergone PVI or the maze procedure (976 patients each). Results: Operative procedures took significantly longer in the Maze Group. Although postoperative AF occurred in 34.3% of the PVI Group patients and in 31.9% of the Maze Group patients (p = 0.371), the incidence of first-time pacemaker implantation was significantly lower in the PVI Group (1.9 vs. 4.1%, respectively; p = 0.005). There was no significant difference in other morbidities or in operative mortality. Postoperative hospital and ICU stays tended to be longer in the Maze Group. Conclusions: Our data indicate that surgical ablation of AF concomitant to non-mitral cardiac surgery is beneficial. Furthermore, PVI and the maze procedure appear to be of equal benefit in this context, except that the maze procedure may more frequently result in the need for pacemaker implantation.

AB - Objective: Although the benefit of surgical ablation for atrial fibrillation (AF) performed concomitant to mitral valve surgery is established, whether that performed concomitant to non-mitral cardiac surgery is beneficial remains unclear. In non-mitral, non-left-atriotomy cardiac surgery, the optimal surgical approach for AF remains to be established. Therefore, using the Japan Adult Cardiovascular Surgery Database (JACVSD), we compared 2 surgical ablation procedures [the maze procedure and pulmonary vein isolation (PVI)] performed concomitant to non-mitral cardiac surgery. Methods: Of 3402 JACVSD patients who had undergone elective non-mitral cardiac surgery by 2012, 1797 (53%) had undergone concomitant PVI, and 1339 (39%) had undergone the maze procedure. To compensate for patient heterogeneity, we conducted a propensity score-matched analysis of 1952 patients who had undergone PVI or the maze procedure (976 patients each). Results: Operative procedures took significantly longer in the Maze Group. Although postoperative AF occurred in 34.3% of the PVI Group patients and in 31.9% of the Maze Group patients (p = 0.371), the incidence of first-time pacemaker implantation was significantly lower in the PVI Group (1.9 vs. 4.1%, respectively; p = 0.005). There was no significant difference in other morbidities or in operative mortality. Postoperative hospital and ICU stays tended to be longer in the Maze Group. Conclusions: Our data indicate that surgical ablation of AF concomitant to non-mitral cardiac surgery is beneficial. Furthermore, PVI and the maze procedure appear to be of equal benefit in this context, except that the maze procedure may more frequently result in the need for pacemaker implantation.

KW - Atrial fibrillation

KW - Maze procedure

KW - Non-mitral cardiac surgery

KW - Pulmonary vein isolation

KW - Surgical ablation

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