News | March 18, 2015

Mitral Valve, Surgical Ablation Combination Frees Patients of Atrial Fibrillation

Study results show no significant increase in mortality, adverse cardiac events or hospitalizations

CTSN, atrial fibrillation, surgical ablation, mitral valve surgery

March 18, 2015 — New study results from The Cardiothoracic Surgical Trials Network (CTSN) show the addition of surgical ablation during mitral valve surgery reduces the occurrence of atrial fibrillation in patients.

The findings — presented March 16 at the American College of Cardiology 64th Annual Scientific Sessions in San Diego and published simultaneously in the New England Journal of Medicine (NEJM) — show a significant amount of patients were free from atrial fibrillation after one year when they received an additional surgical ablation procedure instead of mitral valve surgery alone. Also, the study showed no significant increase in mortality, adverse cardiac events or hospitalizations by adding a surgical ablation procedure to disrupt chaotic electrical signals from atrial fibrillation, which can cause abnormal heart rhythms.

Among those patients receiving ablation, 63 percent were free from atrial fibrillation at six and 12 months after surgery. Only 29 percent who received mitral valve surgery alone were free from atrial fibrillation.

“I think what this shows is that, in the mitral valve surgery patient who has persistent atrial fibrillation, you will achieve better rhythm control by performing ablation, without any increase in mortality or other adverse cardiac events,” said Marc Gillinov, M.D., the Judith Dion Pyle Chair in Heart Valve Research at Cleveland Clinic and the study’s lead author who presented the study.

Approximately 30-50 percent of patients who undergo mitral valve surgery to repair their weak, leaky or hardened valve experience atrial fibrillation, which is a dangerous heart rhythm disorder linked to increased risk of death and stroke. Currently, evidence regarding the safety and effectiveness of surgical ablation has been limited, leading to considerable variation in its use at the time of mitral valve surgery.

“The good news is that a significant proportion of mitral valve surgery patients with atrial fibrillation are already receiving the additional surgical ablation therapy,” said Michael Argenziano, M.D., section chief of adult cardiac surgery at NewYork- Presbyterian/Columbia University Medical Center, associate professor of surgery at Columbia University Medical Center and the study’s senior author. “Our study’s results support this practice and will hopefully lead to even greater adoption of this procedure, allowing more surgical patients to avoid the risks associated with atrial fibrillation.”

To assess its effectiveness as an adjunct procedure to mitral valve surgery, 20 institutions in the United States and Canada enrolled 260 patients with persistent or long-standing persistent atrial fibrillation. These patients received mitral valve surgery alone or mitral valve surgery plus surgical ablation. Patients who were randomly assigned to surgical ablation underwent either pulmonary-vein isolation or the bi-atrial maze procedure. All patients underwent standard left atrial appendage closure during mitral valve surgery to further reduce their risk of stroke.

“The only downside associated with surgical ablation was a 2.5 times greater likelihood of needing a pacemaker implant in the year following their surgery,” said Annetine C. Gelijns, Ph.D., professor and chair of the Department of Population Health Science and Policy at Icahn School of Medicine at Mount Sinai; Gelijns is the corresponding author for the NEJM study and principal investigator for the Data and Clinical Coordinating Center based at Mount Sinai for the NIH-sponsored Cardiothoracic Surgical Trials Network (CTSN). “As such, patients will have to weigh the benefits of a higher probability of being free of atrial fibrillation — with a reduction in its associated complications — versus the higher likelihood of receiving pacemakers.”

This CTSN trial was conducted at eight core clinical centers in the United States and Canada.

For more information: www.ctsurgerynet.org

Related Content

Michigan Hospital Improves Post-CABG Outcomes Using Proactive Amiodarone Protocol
News | Cardiovascular Surgery | October 23, 2019
Proactive administration of amiodarone to patients recovering from a common heart surgery shows promise in preventing...
Gore Block Grant Supports SVS Quality Programs
News | Cardiovascular Surgery | October 17, 2019
W. L. Gore & Associates Inc. will support a new Society for Vascular Surgery (SVS) initiative to advance patient...
Heart and Lung Surgery Patients May Be at High Risk for Opioid Dependence

Image courtesy of the American Heart Association

News | Cardiovascular Surgery | August 22, 2019
The amount of opioids prescribed for patients after heart and lung surgery has a direct relationship with the risk for...
Keck School of Medicine Promotes Patient Diversity in Cardiac Surgery Clinical Trials
News | Cardiovascular Surgery | July 26, 2019
A highly competitive $4.5 million grant from the National Institutes of Health (NIH) National Heart, Lung and Blood...
Google Doodle Celebrates Coronary Artery Bypass Graft Pioneer René Favaloro
News | Cardiovascular Surgery | July 12, 2019 | Jeff Zagoudis, Associate Editor
Internet search engine giant Google unveiled a new Doodle on its homepage Friday, July 12, celebrating the life and...
Open Heart Surgery Outperforms Stents in Patients With Multivessel Disease
News | Cardiovascular Surgery | May 03, 2019
Coronary artery bypass grafting (CABG) surgery may be the best treatment option for most patients with more than one...
SherpaPak Cardiac Transport System Cleared for Pediatric and Small Donor Hearts
Technology | Cardiovascular Surgery | February 01, 2019
Paragonix Technologies Inc. recently received clearance from the U.S. Food and Drug Administration (FDA) for a design...
Transplanting Pig Hearts Into Humans One Step Closer. A pig heart, shown here, is very similar in size and anatomy to a human heart. For this reason, pigs are used extensively in pre-clinical animal testing for new implantable cardiovascular devices. If pig hearts could be used for human transplantation, it would greatly alleviate shortages of donor human hearts.

A pig heart, shown here, is very similar in size and anatomy to a human heart. For this reason, pigs are used extensively in pre-clinical animal testing for new implantable cardiovascular devices. If pig hearts could be used for human transplantation, it would greatly alleviate shortages of donor human hearts.

News | Cardiovascular Surgery | December 11, 2018
The scientific journal Nature recently published an article from Munich University Hospital which describes the long-...
Bilateral Artery Use Does Not Improve 10-Year CABG Outcomes
News | Cardiovascular Surgery | September 06, 2018
While it is firmly established that the use of one internal thoracic artery can improve life expectancy in coronary...
Overlay Init