PMID- 28669501
OWN - NLM
STAT- MEDLINE
DCOM- 20170905
LR  - 20170906
IS  - 1552-6259 (Electronic)
IS  - 0003-4975 (Linking)
VI  - 104
IP  - 2
DP  - 2017 Aug
TI  - Surgical Ablation of Atrial Fibrillation in the United States: Trends and 
      Propensity Matched Outcomes.
PG  - 493-500
LID - S0003-4975(17)30690-2 [pii]
LID - 10.1016/j.athoracsur.2017.05.016 [doi]
AB  - BACKGROUND: Surgical ablation (SA) for atrial fibrillation (AF) effectively 
      restores sinus rhythm. Incompletely defined risk has previously limited 
      concomitant performance of SA during cardiac operations. The study goals were to 
      define performance trends and risk-adjusted outcomes for contemporary SA. 
      METHODS: From July 2011 to June 2014, 86,941 patients with AF, but without 
      endocarditis, underwent primary nonemergent cardiac operations in The Society of 
      Thoracic Surgeons (STS) database. Cochran-Armitage tests examined performance 
      trends of SA for six operative categories: mitral valve repair or replacement 
      (MVRR) with or without coronary artery bypass graft surgery (CABG), aortic valve 
      replacement (AVR) with or without CABG, CABG, AVR with MVRR, stand-alone SA, and 
      other concomitant operations. The risk of concomitant SA was analyzed by 
      propensity matching 28,739 patient-pairs with and without SA by AF type, primary 
      operation, and STS comorbid risk variables using greedy 1:1 matching algorithms. 
      RESULTS: Among all patients with AF, 48.3% (42,066 of 86,941) underwent SA. 
      Mitral operations had the highest rate of SA (MVRR +/- CABG 68.4% [14,693 of 
      21,496]; MVRR + AVR 59.1% [1,626 of 2,750]). The AVR +/- CABG and isolated CABG 
      rates were 39.3% (6,816 of 17,349) and 32.8% (9,156 of 27,924), respectively. 
      Nearly half of other concomitant operations underwent SA, 47.6% (6,939 of 
      14,586). Performance frequency increased throughout the study period. After 
      propensity matching, SA was associated with a reduction in relative risk (RR) of 
      30-day mortality (RR 0.92, 95% confidence interval [CI]: 0.85 to 0.99) and stroke 
      (RR 0.84, 95% CI: 0.74 to 0.94), but an increase in renal failure (RR 1.12, 95% 
      CI: 1.03 to 1.22) and pacemaker implantation (RR 1.33, 95% CI: 1.24 to 1.43). 
      CONCLUSIONS: Contemporary utilization of SA is increasing across all operative 
      categories. Performance of SA is accompanied by a 30-day reduction in mortality 
      and stroke. These findings further refine our understanding of the role of SA in 
      the treatment of AF.
CI  - Copyright (c) 2017 The Society of Thoracic Surgeons. Published by Elsevier Inc. All 
      rights reserved.
FAU - Badhwar, Vinay
AU  - Badhwar V
AD  - Department of Cardiovascular and Thoracic Surgery, West Virginia University, 
      Morgantown, West Virginia. Electronic address: vinay.badhwar@wvumedicine.org.
FAU - Rankin, J Scott
AU  - Rankin JS
AD  - Department of Cardiovascular and Thoracic Surgery, West Virginia University, 
      Morgantown, West Virginia.
FAU - Ad, Niv
AU  - Ad N
AD  - Department of Cardiovascular and Thoracic Surgery, West Virginia University, 
      Morgantown, West Virginia.
FAU - Grau-Sepulveda, Maria
AU  - Grau-Sepulveda M
AD  - Duke Clinical Research Institute, Durham, North Carolina.
FAU - Damiano, Ralph J
AU  - Damiano RJ
AD  - Division of Cardiothoracic Surgery, Washington University, St. Louis, Missouri.
FAU - Gillinov, A Marc
AU  - Gillinov AM
AD  - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, 
      Ohio.
FAU - McCarthy, Patrick M
AU  - McCarthy PM
AD  - Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
FAU - Thourani, Vinod H
AU  - Thourani VH
AD  - Division of Cardiothoracic Surgery, Emory University, Atlanta, Georgia.
FAU - Suri, Rakesh M
AU  - Suri RM
AD  - Department of Thoracic and Cardiovascular Surgery, Cleveland Clinic, Cleveland, 
      Ohio.
FAU - Jacobs, Jeffrey P
AU  - Jacobs JP
AD  - Division of Cardiac Surgery, Johns Hopkins University School of Medicine, 
      Baltimore, Maryland.
FAU - Cox, James L
AU  - Cox JL
AD  - Division of Cardiac Surgery, Northwestern University Feinberg School of Medicine, 
      Chicago, Illinois.
LA  - eng
PT  - Journal Article
PT  - Multicenter Study
DEP - 20170629
PL  - Netherlands
TA  - Ann Thorac Surg
JT  - The Annals of thoracic surgery
JID - 15030100R
SB  - IM
MH  - Aged
MH  - Aged, 80 and over
MH  - Atrial Fibrillation/*surgery
MH  - Catheter Ablation/*trends
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Middle Aged
MH  - Morbidity/trends
MH  - Postoperative Complications/*epidemiology
MH  - Propensity Score
MH  - Retrospective Studies
MH  - *Risk Assessment
MH  - Survival Rate
MH  - Treatment Outcome
MH  - United States/epidemiology
EDAT- 2017/07/04 06:00
MHDA- 2017/09/07 06:00
CRDT- 2017/07/04 06:00
PHST- 2016/11/20 00:00 [received]
PHST- 2017/04/02 00:00 [revised]
PHST- 2017/05/05 00:00 [accepted]
PHST- 2017/07/04 06:00 [pubmed]
PHST- 2017/09/07 06:00 [medline]
PHST- 2017/07/04 06:00 [entrez]
AID - S0003-4975(17)30690-2 [pii]
AID - 10.1016/j.athoracsur.2017.05.016 [doi]
PST - ppublish
SO  - Ann Thorac Surg. 2017 Aug;104(2):493-500. doi: 10.1016/j.athoracsur.2017.05.016. 
      Epub 2017 Jun 29.