Table 3.
Data from recent trials in larger cohorts
| First author references (year) | Cases/participants | Age, years | Follow-up, years (unless otherwise indicated) | Study type | Key findings/messages |
|---|---|---|---|---|---|
| Gillinov et al. [33] |
260 persistent or longstanding persistent AF patients who were to undergo mitral valve surgery were randomized to maze surgery or PVI only versus no AF surgery |
69 ± 10 | 6-month assessment and 12-month assessment | Randomized multi-center study |
Significantly more patients in the ablation group were free of AF at 6 and 12 months (P < 0.001) More permanent pacemaker placement required in surgical group Ablative energy sources were not uniform and may have reduced success rates |
| Suwalski et al. [39] |
11,381 patients with AF underwent mitral valve surgery (MVS) 2449 (21.5%) also underwent AF surgical ablation |
65.6 ± 9.0 | Median follow-up 5 years | Retrospectively collected data from the KROK (Polish National Registry of Cardiac Surgery Procedures) registry |
AF surgical ablation group was younger (63.8 ± 8.7 years vs. 66.1 ± 9.0 years; p < 0.001) MVS + AF ablation resulted in significant survival benefit over MVS alone (p < 0.001) |
| Malaisrie et al. [37] | Data from the 9771 CABG patients treated with surgical ablation were compared with 9,771 CABG patients who were not surgically ablated | 74 | Median follow-up 4 years | A one-to-one optimal matching algorithm was employed to obtain propensity score matched samples |
Operative and in hospital mortality were significantly higher in the ablation group Among patients surviving past 2 years mortality and incidence of stroke or systemic embolization was lower in the ablation group |
| Suwalski et al. [38] | 306 cases of isolated CABG + ablation versus 918 of isolated CABG alone | Median 62 | 4.7 ± 3.5 years |
1:3 propensity matching Data collected retrospectively from the KROK (Polish National Registry of Cardiac Surgery Procedures) registry |
CABG + ablation was associated with a statistically lower risk of 30-day death (P = 0.032) Performing ablation at the time of isolated CABG was also associated with a significant long-term survival benefit (P = 0.008) |
| Musharbash et al. [40] |
10,859 total AF + Cox-maze IV 438 AF—Cox-maze IV 1510 No AF 8911 |
After matching: AF + Cox-maze IV = 68 ± 11 versus AF w/o Cox-maze IV = 68 ± 14 AF + Cox-maze IV = 66 ± 11 versus No AF = 66 ± 12 |
Mean follow-up between the AF + Cox-maze IV and AF w/o Cox-maze IV groups was 4.2 ± 3.4 years and 3.8 ± 3.8 years. Between the AF + Cox-maze IV and the No AF group was 4.0 ± 3.4 years and 3.9 ± 3.8 years | Retrospective review of patients undergoing cardiac surgery 2001 to 2016 with propensity matching |
Survival greater with concomitant Cox-maze IV compared to AF that was untreated No significant difference in 10-year survival between Cox-maze IV recipients and the group without AF |
| Iribarne et al. [41] | 2740 with documented pre-op AF |
Surgical ablation recipients 71.7 No ablation patients 71.9 |
Mean long-term survival follow-up was 2.6 years | Retrospective multicenter cohort of patients with AF who underwent CABG, valve, and valve plus CABG comparing surgical ablation versus no surgical ablation |
No differences in postoperative complications Length of stay shorter in ablation recipients (p < 0.001) Ablated patients had improved 5-year survival |
| Badhwar et al. [42] |
86,941 total 42,066 (48.3%) underwent surgical ablation 28,739 pairs were propensity matched |
Median (interquartile range)* Overall: 72 (65–79) No ablation: 73 (65–80) Ablation: 71 (64–78) |
47 months** | US surgical ablative propensity matched performance trends for six operative categories: 1) AVR ± CABG, 2) MVRR ± CABG, 3) AVR with MVRR, 4) CABG alone, 5) stand-alone surgical ablation, and 6) surgical ablation plus other concomitant operations | Risk-adjusted mortality, stroke, and prolonged ventilation were reduced in ablation recipients. However, renal failure and new pacemakers were increased after surgical ablation |
US United States, AF atrial fibrillation, AVR aortic valve replacement, CABG coronary artery bypass graft surgery, MVRR mitral valve repair or replacement, MVS mitral valve surgery, PVI pulmonary-vein isolation, w/o without. *Unadjusted values. **Ill-defined in original manuscript