title: Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right-Sided Heart Remodeling After Mitral-Valve Surgery: A Propensity-Score Matching Analysis.
abstract: This study assessed the role of surgical ablation for atrial fibrillation (AF) in decreasing tricuspid regurgitation (TR) and right-sided heart remodeling in patients after mitral valve procedure.
  
  
  
  Between 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity-score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate-to-severe TR, as well as echocardiography indices in long-term follow-up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [HR], 1.644; 95% CI, 1.081-2.501; P=0.020), reoperation (HR, 2.644; 95% CI, 1.299-5.466; P=0.008), and moderate-to-severe TR (HR, 1.436; 95% CI, 1.059-1.948; P=0.020), associated with a significantly deteriorated cardiac function, progression of TR, and right-sided heart remodeling after 5-year follow-up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5-year follow-up. The recurrent group showed significantly higher risks of moderate-to-severe TR (HR, 2.427; 95% CI, 1.261-4.671; P=0.008). AF recurrence was associated with progressive TR and significant deterioration in right-sided heart remodeling.
  
  
  
  In a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right-sided heart remodeling, which are alleviated by surgical ablation.
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China jiangangwang@ccmu.edu.cn mxu@263.net.
authors.forename: Jiangang
authors.initials: J
authors.lastname: Wang
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Jie
authors.initials: J
authors.lastname: Han
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: The Heart Center, First Hospital of Tsinghua University, Beijing, China.
authors.forename: Qing
authors.initials: Q
authors.lastname: Ye
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Meng
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Tiange
authors.initials: T
authors.lastname: Luo
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Baiyu
authors.initials: B
authors.lastname: Tian
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Haibo
authors.initials: H
authors.lastname: Zhang
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yixin
authors.initials: Y
authors.lastname: Jia
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Wen
authors.initials: W
authors.lastname: Zeng
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Chunlei
authors.initials: C
authors.lastname: Xu
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Wei
authors.initials: W
authors.lastname: Han
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
authors.forename: Yuqing
authors.initials: Y
authors.lastname: Jiao
authors.affiliation: Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, Beijing, China jiangangwang@ccmu.edu.cn mxu@263.net.
authors.forename: Xu
authors.initials: X
authors.lastname: Meng
mesh_terms: D000328:Adult; D001281:Atrial Fibrillation / Q000150:complications / Q000601:surgery*; D064752:Atrial Remodeling; D017115:Catheter Ablation; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D019918:Heart Valve Prosthesis Implantation; D006801:Humans; D008297:Male; D008875:Middle Aged; D058386:Mitral Valve Annuloplasty; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000601:surgery*; D057216:Propensity Score; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D014262:Tricuspid Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D020257:Ventricular Remodeling
keywords: ablation; atrial fibrillation; mitral valve; remodeling; tricuspid regurgitation