Impact of Surgical Ablation of Atrial Fibrillation on the Progression of Tricuspid Regurgitation and Right‐Sided Heart Remodeling After Mitral‐Valve Surgery: A Propensity‐Score Matching Analysis

Abstract

Background This study assessed the role of surgical ablation for atrial fibrillation ( AF ) in decreasing tricuspid regurgitation ( TR ) and right‐sided heart remodeling in patients after mitral valve procedure. Methods and Results Between 1994 and 2014, 1568 consecutive patients with AF undergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation of AF was used. Propensity‐score matching ( PSM ) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate‐to‐severe TR , as well as echocardiography indices in long‐term follow‐up, were compared in 406 matched patient pairs (ablated and nonablated groups). The nonablated group showed significantly higher risks of death (hazard ratio [ HR ], 1.644; 95% CI , 1.081–2.501; P =0.020), reoperation ( HR , 2.644; 95% CI , 1.299–5.466; P =0.008), and moderate‐to‐severe TR ( HR , 1.436; 95% CI , 1.059–1.948; P =0.020), associated with a significantly deteriorated cardiac function, progression of TR , and right‐sided heart remodeling after 5‐year follow‐up. In a subgroup comparison of ablated patients with sinus rhythm versus AF recurrence, a PSM analysis was performed at the 5‐year follow‐up. The recurrent group showed significantly higher risks of moderate‐to‐severe TR ( HR , 2.427; 95% CI , 1.261–4.671; P =0.008). AF recurrence was associated with progressive TR and significant deterioration in right‐sided heart remodeling. Conclusions In a retrospective PSM analysis, mitral valve disease with AF was associated with TR progression as well as right‐sided heart remodeling, which are alleviated by surgical ablation.