Piotr Suwalski1, Mariusz Kowalewski1,2,3, Marek Jasiński4, Jakub Staromłyński1, Marian Zembala5, Kazimierz Widenka6, Mirosław Brykczyński7, Jacek Skiba8, Michał Oskar Zembala5, Krzysztof Bartuś9, Tomasz Hirnle10, Inga Dziembowska11, Marek Deja12,13, Zdzisław Tobota14, Bohdan J Maruszewski14. 1. Department of Cardiac Surgery, Central Clinical Hospital of the Ministry of Interior, Centre of Postgraduate Medical Education, Warsaw, Poland. 2. Cardiothoracic Research Centre, Innovative Medical Forum, Bydgoszcz, Poland. 3. Cardio-Thoracic Surgery Department, Heart and Vascular Centre, Maastricht University Medical Centre, Maastricht, Netherlands. 4. Department and Clinic of Cardiac Surgery, Wroclaw Medical University, Wroclaw, Poland. 5. Division of Cardiac Surgery, Heart and Lung Transplantation and Mechanical Circulatory Support, Silesian Center for Heart Disease, Zabrze, Poland. 6. Clinical Department of Cardiac Surgery, District Hospital no. 2, University of Rzeszów, Rzeszów, Poland. 7. Department of Cardiac Surgery, Pomeranian Medical University, Szczecin, Poland. 8. Department of Cardiac Surgery, 4 Military Clinical Hospital Centre for Heart Diseases, Wroclaw, Poland. 9. Department of Cardiovascular Surgery and Transplantology, Jagiellonian University, John Paul II Hospital, Krakow, Poland. 10. Department of Cardiosurgery, Medical University of Bialystok, Bialystok, Poland. 11. Department of Pathophysiology, Faculty of Pharmacy, Collegium Medicum, Nicolaus Copernicus University, Toruń, Poland. 12. Department of Cardiac Surgery, School of Medicine in Katowice, Medical University of Silesia, Katowice, Poland. 13. Department of Cardiac Surgery, Upper-Silesian Heart Center, Katowice, Poland. 14. Department of Pediatric Cardiothoracic Surgery, The Children's Memorial Health Institute, Warsaw, Poland.
Abstract
OBJECTIVES: Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). METHODS: Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7-7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG. RESULTS: Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolated CABG + ablation vs 918 of isolated CABG alone), surgical ablation was associated with a lower 30-day risk of death [risk ratio 0.37, 95% confidence interval (CI) 0.15-0.91; P = 0.032] and multiorgan failure (risk ratio 0.29, 95% CI 0.10-0.94; P = 0.029). In the long term, surgical ablation was associated with a significant 33% improved overall survival rate: hazard ratio 0.67, 95% CI 0.49-0.90; P = 0.008. The benefit of ablation was sustained in the subgroups but was most pronounced in lower risk older patients (age >70 years, P = 0.020; elective status, P = 0.011) with 3-vessel disease (P = 0.036), history of a cerebrovascular accident (P = 0.018) and preserved left ventricular function [left ventricular ejection fraction >50%; P = 0.017; no signs of heart failure (per New York Heart Association functional class); P = 0.001] and those undergoing on-pump CABG (P < 0.001). CONCLUSION: Surgical ablation for AF in patients undergoing isolated CABG is safe and associated with significantly improved long-term survival.
OBJECTIVES: Our goal was to evaluate early sequelae and long-term survival in patients undergoing isolated coronary artery bypass grafting (CABG) with concomitant surgical ablation for atrial fibrillation (AF). METHODS: Procedural data from KROK (Polish National Registry of Cardiac Surgery Procedures) were collected. A total of 7879 patients with underlying AF underwent isolated CABG between 2006 and 2018 in 37 reference centres across Poland. The mean follow-up was 4.7 ± 3.5 years [median (interquartile range) 4.3 (1.7-7.4)]. Propensity score matching and Cox proportional hazards models were used to compare isolated CABG + ablation with isolated CABG. RESULTS: Of the included patients, 346 (4.39%) underwent surgical ablation. Patients in this group were significantly younger (66.4 ± 7.5 vs 69.2 ± 8.2; P < 0.001) but had a non-significant, different baseline surgical risk (EuroSCORE: 2.11 vs 2.50; P = 0.088). After a rigorous 1:3 propensity matching (LOGIT model: 306 cases of isolated CABG + ablation vs 918 of isolated CABG alone), surgical ablation was associated with a lower 30-day risk of death [risk ratio 0.37, 95% confidence interval (CI) 0.15-0.91; P = 0.032] and multiorgan failure (risk ratio 0.29, 95% CI 0.10-0.94; P = 0.029). In the long term, surgical ablation was associated with a significant 33% improved overall survival rate: hazard ratio 0.67, 95% CI 0.49-0.90; P = 0.008. The benefit of ablation was sustained in the subgroups but was most pronounced in lower risk older patients (age >70 years, P = 0.020; elective status, P = 0.011) with 3-vessel disease (P = 0.036), history of a cerebrovascular accident (P = 0.018) and preserved left ventricular function [left ventricular ejection fraction >50%; P = 0.017; no signs of heart failure (per New York Heart Association functional class); P = 0.001] and those undergoing on-pump CABG (P < 0.001). CONCLUSION: Surgical ablation for AF in patients undergoing isolated CABG is safe and associated with significantly improved long-term survival.
Authors: Vojtech Kurfirst; Julia Csanady; Ales Mokracek; Jiri Hanis; Alan Bulava; Ladislav Pesl Journal: Kardiochir Torakochirurgia Pol Date: 2020-04-07
Authors: Mariusz Kowalewski; Marek Jasiński; Jakub Staromłyński; Marian Zembala; Kazimierz Widenka; Mirosław Brykczyński; Jacek Skiba; Michał Zembala; Krzysztof Bartuś; Tomasz Hirnle; Inga Dziembowska; Piotr Knapik; Zdzisław Tobota; Bohdan Maruszewski; Piotr Suwalski Journal: PLoS One Date: 2020-04-22 Impact factor: 3.240
Authors: Michal Pasierski; Jakub Staromłyński; Janina Finke; Radoslaw Litwinowicz; Grzegorz Filip; Adam Kowalówka; Wojciech Wańha; Michalina Kołodziejczak; Natalia Piekuś-Słomka; Andrzej Łoś; Sebastian Stefaniak; Wojciech Wojakowski; Marek Jemielity; Jan Rogowski; Marek Deja; Dariusz Jagielak; Krzysztof Bartus; Silvia Mariani; Tong Li; Matteo Matteucci; Daniele Ronco; Federica Jiritano; Dario Fina; Gennaro Martucci; Paolo Meani; Giuseppe Maria Raffa; Artur Słomka; Pietro Giorgio Malvidni; Roberto Lorusso; Michal Zembala; Piotr Suwalski; Mariusz Kowalewski Journal: Front Cardiovasc Med Date: 2022-06-15
Authors: Mariusz Kowalewski; Marek Jasiński; Jakub Staromłyński; Marian Zembala; Kazimierz Widenka; Michał Oskar Zembala; Krzysztof Bartuś; Tomasz Hirnle; Inga Dziembowska; Piotr Knapik; Marek Deja; Waldemar Wierzba; Zdzisław Tobota; Bohdan J Maruszewski; Piotr Suwalski Journal: J Clin Med Date: 2020-05-04 Impact factor: 4.241