Left Atrium Volume Reduction Procedure Concomitant With Cox-Maze Ablation in Patients Undergoing Mitral Valve Surgery: A Meta-Analysis of Clinical and Rhythm Outcomes

The management of an enlarged left atrium (LA) in mitral valve (MV) disease with atrial fibrillation (AF) is still being debated. It has been postulated that a reduction in LA size may improve patient outcomes. This meta-analysis aimed to assess rhythm and clinical outcomes of combined surgical AF t...

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Published in:Heart, lung & circulation lung & circulation, 2023-11, Vol.32 (11), p.1386-1393
Main Authors: Baudo, Massimo, Rosati, Fabrizio, Di Bacco, Lorenzo, D’Alonzo, Michele, Benussi, Stefano, Muneretto, Claudio
Format: Article
Language:English
Subjects:
Atrial fibrillation ablation
Cardiac surgery
Left atrium volume reduction surgery
Meta-analysis
Mitral valve surgery
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Summary:The management of an enlarged left atrium (LA) in mitral valve (MV) disease with atrial fibrillation (AF) is still being debated. It has been postulated that a reduction in LA size may improve patient outcomes. This meta-analysis aimed to assess rhythm and clinical outcomes of combined surgical AF treatment with or without LA volume reduction (LAVR) in patients undergoing MV surgery. A systematic review was performed and all available literature to May 2022 was included. The primary endpoint was analysis of early and late mortality and rhythm outcomes. Secondary outcomes included early and late cerebrovascular accident (CVA) and permanent pacemaker implantation. The search strategy yielded 2,808 potentially relevant articles, and 19 papers were eventually included. The pooled estimated rate of 30-day mortality was 3.76% (95% CI 2.52–5.56). The incidence rate of late mortality and late cardiac-related mortality was 1.75%/year (95% CI 0.63–4.84) and 1.04%/year (95% CI 0.31–3.53), respectively. At subgroup analysis when comparing the surgical procedure with and without AF ablation, the ablation subgroup showed a significantly lower rate of postoperative CVA (p
ISSN:1443-9506
1444-2892
DOI:10.1016/j.hlc.2023.09.009