Mariusz Kowalewski: Risk Stratification of Surgical Ablation During Minimally Invasive Mitral Valve Surgery for AFib
Mariusz Kowalewski, Professor of Medicine w Państwowy Instytut Medyczny MSWiA, shared a post on LinkedIn about a recent article he and his colleagues co-authored, published in Sage Journals, adding:
“Excited to share our latest research now available in Innovations!
Does the benefit of adding surgical ablation (SA) for AFib during minimally invasive mitral valve surgery (MIMVS) depend on the patient’s baseline risk?
Our new analysis from the Polish National Registry of Cardiac Surgery Procedures (KROK) suggests yes.
What We Found:
While SA is established in sternotomy cases, its role in healthier MIMVS patients has been less clear.
Our study of over 1,500 patients (2006 to 2021) shows that adding SA to MIMVS is safe, with no increase in 24h mortality or in hospital complications. In fact, the SA group had fewer neurologic complications (2.7 percent vs 8.2 percent).
The Key Takeaway:
Although unadjusted survival favored SA, this benefit disappeared after adjusting for baseline risk.
However, a clear gradient of benefit emerged when stratified by CHA₂DS₂ VASc score.
Patients at higher thromboembolic risk gained the most from concomitant ablation.
Clinical Implications:
- The CHA₂DS₂ VASc scale may serve as a valuable tool for surgical outcomes in AFib patients, alongside STS and EuroSCORE.
- MIMVS with SA is a safe combination.
- Lower risk MIMVS patients should not be automatically denied SA, but those with higher baseline risk are gaining most.
This data supports a more nuanced, risk stratified approach to surgical AFib treatment, including hybrid approaches as well.”
Title: Surgical Ablation for Atrial Fibrillation During Minimally Invasive Mitral Valve Surgery: Risk Dependencies and Long-Term Survival
Authors: Mariusz Kowalewski, Giuseppe Maria Raffa, Jakub Batko, Michał Święczkowski, Emil Julian Dąbrowski, Karol Gostomczyk, Łukasz Kuźma, Wojciech Wańha, Radosław Litwinowicz, Tomasz Urbanowicz, Fabrizio D’Ascenzo, Marek Jasiński, Kazimierz Widenka, Marek Deja, Krzysztof Bartuś, Tomasz Hirnle, Wojciech Wojakowski, Michele Pilato, Francesco Musumeci, Roberto Lorusso, Calogera Pisano, Zdzisław Tobota, Bohdan J. Maruszewski, Piotr Suwalski
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