Abstract：
BACKGROUND: Despite prospective randomized evidence supporting concomitant treatment of atrial fibrillation (AF) during mitral valve (MV) surgery, variation in surgical management of AF remains. We assessed longitudinal outcomes after surgical treatment of persistent or paroxysmal AF during MV surgery in Medicare beneficiaries.
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.
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.
摘要：
背景：尽管有前瞻性随机证据支持二尖瓣（MV）手术期间合并治疗心房颤动（AF），房颤的外科治疗仍然存在差异。我们试图评估Medicare受益人在MV手术期间对持续性或阵发性房颤进行手术治疗后的纵向结果。
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。
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。
