Surgical treatment of atrial fibrillation in high-risk patients with mitral valve deasise

Abstract

Objective. To find out if the surgical treatment of atrial fibrillation in high-risk patients with EuroSCORE >6 can be safe and effective.Methods and materials. We have conducted a retrospective analysis of 438 high-risk patients with EuroSCORE >6 who have undergone surgery at FSBI `FCSC` of Health Ministry of the Russian Federation (Penza) since 2009. The patients were divided into 2 groups: group 1 consists of 61 patients underwent a Cox-Maze IV open-heart surgical procedure; group 2 consists of 61 patients who didn`t undergo any surgical treatment of heart rhythm disorder and who had no history of atrial fibrillation. Propensity score matching method (PSM) was used to make the control group. The duration of anamnesis was 45.0±27.8 months, the left atrial dimension was 71.1±13.3 mm. The percentage of patients with the permanent form of atrial fibrillation was 100%. All patients from group 1 underwent a Cox-Maze IV procedure. Results. The groups did not differ with regard to postoperative period, complications, mortality. The remote results at follow-up terms varying from 6 months to 3 years were assessed among 100% of patients. The average NYHA functional class in group 1 was 1.9±0.6, whereas it was 1.8±0.5 in group 2. The key points of the research were 12, 24 and 36 months. The actuarial freedom from atrial fibrillations in group 1 was 75.9%±1.9%. The 3 -year survival rate was 100%.Conclusions. The high EuroSCORE>6 should not be the determinative factor in the refusal of surgical treatment of atrial fibrillation in patients who are to undergo an open-heart surgery. A concomitant Cox-Maze IV procedure does not increase complications in the postoperative period; it also does not influence the mortality and the time of hospitalization. Main factors associated with recurrent AF in high-risk patients preserve long-term SR in 75% patients.Key words: atrial fibrillation, radiofrequency ablation, mitral valve