METHODS: All Medicare beneficiaries with a diagnosis of AF undergoing MV surgery (2018-2020) were evaluated. Patients were stratified by no AF treatment, left atrial appendage obliteration (LAAO) alone, or surgical ablation and LAAO (SA+LAAO). Doubly robust risk adjustment and subgroup analysis by persistent or paroxysmal AF were performed.
RESULTS: A total of 7517 patients with preoperative AF underwent MV surgery (32.1% no AF treatment, 23.1% LAAO alone, 44.7% SA+LAAO). After doubly robust risk adjustment, AF treatment with SA+LAAO or LAAO alone were associated with lower 3-year readmission for stroke or bleeding. However, SA+LAAO was associated with reduced 3-year mortality and readmission for AF or heart failure compared with no AF treatment or LAAO alone. Compared with no AF treatment or LAAO alone, SA+LAAO was associated with lower composite end point of stroke (hazard ratio, 0.75) or death (hazard ratio, 0.83) at 3 years. Subgroup analysis identified similar longitudinal benefits of SA+LAAO in patients with persistent or paroxysmal AF.
CONCLUSIONS: In Medicare beneficiaries with AF undergoing MV surgery, SA+LAAO was associated with improved longitudinal outcomes compared with LAAO alone or no AF treatment in patients with paroxysmal or persistent AF. These contemporary real-world data further clarify the benefit of SA+LAAO during MV surgery across all types of AF.
方法:评估了所有诊断为房颤的接受MV手术(2018-2020年)的Medicare受益人。通过无房颤治疗、单独左心耳消融(LAAO)、LAAO和手术消融(SA+LAAO)对患者进行分层。通过持续性或阵发性房颤进行双重稳健的风险调整和亚组分析。
结果:共有7,517例术前房颤患者接受了MV手术(32.1%未接受房颤治疗,单独23.1%LAAO,44.7%SA+LAAO)。经过双重稳健的风险调整后,使用SA+LAAO或单独使用LAAO的AF治疗与较低的3年卒中或出血再入院相关。然而,SA+LAAO与降低3年死亡率相关,房颤或心力衰竭的再入院,与没有房颤治疗或单独LAAO相比。与无房颤治疗或单独使用LAAO相比,SA+LAAO与较低的3年卒中或死亡复合终点相关(分别为HR0.75和HR0.83)。亚组分析发现,在持续性或阵发性房颤患者中,SA+LAAO的纵向益处相似。
结论:在接受MV手术的AF的Medicare受益人中,在阵发性或持续性房颤患者中,与单独使用LAAO或不使用房颤治疗相比,SA+LAAO可改善纵向结局。这些当代现实世界数据进一步阐明了在所有类型AF的二尖瓣手术期间SA+LAAO的益处。