Journal Article

Surgical ablation in non-mitral valve cardiac surgeries: a meta-analysis of early outcomes

Fukunaga, Christian Ken, Kirov, Hristo, Barbosa, Gabriel Scarpioni, Gioli-Pereira, Luciana, Fabiano, Ronaldo Correa, Caldonazo, Túlio, Katsuyama, Eric Shih, Fernandes, Julia M, Coan, Ana Carolina C, Palatianos, Yoana, Doenst, Torsten

2026

Overview

BackgroundSurgical ablation (SA) is a key treatment for atrial fibrillation (AF) patients undergoing heart surgery. However, direct comparisons between SA and non-mitral valve (non-MV) surgery alone are lacking. We performed a systematic review and meta-analysis comparing concomitant SA to isolated non-MV surgery in AF patients.MethodsMEDLINE, Embase and Cochrane were searched. Outcomes of interest were: (1) postoperative AF (POAF); (2) early all-cause mortality; (3) postoperative pacemaker implantation and (4) stroke. Additionally, a subgroup analysis comparing randomised controlled trials (RCTs) and propensity score-matched studies (PSM) was conducted. Risk ratios (RRs) and their respective 95% CI were calculated using a random effects model.ResultsAfter screening 6423 citations, we included 2 RCTs and 5 PSM studies encompassing 39 348 AF patients undergoing non-MV surgery, of whom 18 394 (46.7%) underwent SA. Compared with isolated non-MV surgery, SA was associated with significant POAF reduction (RR: 0.73; 95% CI: 0.67 to 0.79; I2=0%) and higher risk of postoperative pacemaker implantation (RR: 1.34; 95% CI: 1.14 to 1.57, I2=0%) compared with surgery alone. No differences were found in early all-cause mortality (RR: 0.96; 95% CI: 0.76 to 1.22; I2=65%) and postoperative stroke (RR: 1.06; 95% CI: 0.89 to 1.26; I2=0%). The subgroup analysis comparing RCTs and PSM showed significant consistency among the different designs.ConclusionsIn this meta-analysis, SA was associated with POAF reduction in non-MV surgery. In terms of safety, it was suggested that although no difference in early mortality and postoperative stroke was observed, SA had a higher risk of pacemaker implantation than isolated non-MV surgery.

• Publisher: BMJ Publishing Group Ltd and British Cardiovascular Society,BMJ Publishing Group LTD
• Subject: Ablation / Atrial Fibrillation - complications / Atrial Fibrillation - mortality / Atrial Fibrillation - physiopathology / Atrial Fibrillation - surgery / Bias / Cardiac arrhythmia / Cardiac Surgical Procedures - adverse effects / Cardiac Surgical Procedures - methods / Cardiac Surgical Procedures - mortality / Catheter Ablation - adverse effects / Catheter Ablation - methods / Catheter Ablation - mortality / Coronary vessels / Heart surgery / Humans / Meta-analysis / Mortality / Observational studies / Pacemaker, Artificial / Pacemakers / Patients / Postoperative Complications / Risk Factors / Stroke / Stroke - etiology / Systematic review / Treatment Outcome / Veins & arteries