Clinical efficacy of minimally invasive cardiac valve surgery concomitant with radiofrequency ablation for atrial fibrillation: a single-center retrospective study.
- 1Department of Cardiac Surgery, Zhongnan Hospital of Wuhan University, Wuhan, China.
Abstract
Concomitant atrial fibrillation (AF) and valvular heart disease (VHD) present complex clinical challenges. Standard radiofrequency ablation (RFA) combined with valve surgery via median sternotomy offers robust rhythm correction but causes significant surgical trauma. Minimally invasive cardiac valve surgery with concomitant RFA (MICVS-RFA) is a promising strategy, but clinical data regarding its comprehensive safety, efficacy, and predictive risk factors for AF recurrence remain scarce. Thus, we aimed to evaluate the safety and clinical efficacy of MICVS-RFA and to develop an exploratory prognostic model for risk stratification. We retrospectively analyzed 146 patients with concomitant VHD and AF who underwent MICVS-RFA between April 1, 2020, and August 1, 2025. Surgical cohorts included mitral valve replacement (MVR; n=34), mitral valve repair (MVr; n=19), MVR combined with tricuspid valve repair (MVR + TVr; n=57), and MVr combined with tricuspid valve repair (MVr + TVr; n=36). Pre-operative predictors for post-operative AF recurrence were identified using least absolute shrinkage and selection operator (LASSO) and elastic net regularization integrated within a multiple imputation framework to develop an exploratory model. Left ventricular ejection fraction (LVEF) improvements were assessed dynamically. Procedural success was achieved in all 146 patients, with an overall 30-day freedom from recurrent AF (FFAF) rate of 89.7% and no observed major adverse events (stroke, bleeding, or thromboembolism) within the first post-operative month. Length of stay (LOS) showed no statistical differences among surgical cohorts (P=0.71). Logistic regression modeling identified pre-operative metoprolol usage as associated with lower odds of AF recurrence [odds ratio (OR) =0.17; 95% confidence interval (CI): 0.04-0.62], while pre-operative pulmonary hypertension (PH) showed a non-significant association with higher odds of AF recurrence (OR =3.07; 95% CI: 0.67-14.10). The predictive model showed moderate discrimination [bootstrap-corrected area under the receiver operating characteristic curve (AUC) =0.773] and apparent calibration. Patients with baseline LVEF <55% experienced superior functional recovery compared to those with LVEF ≥55% (ΔLVEF: 13.07%±2.56% vs. 0.18%±0.80%, P<0.001). MICVS-RFA was a feasible "dual minimally invasive" strategy that permits concomitant treatment of valvular pathology and AF through a minimally invasive approach, minimizing perioperative trauma. Comparative and long-term effects require further study.
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BibTeX
@article{wu2026clinical,
title = {{Clinical efficacy of minimally invasive cardiac valve surgery concomitant with radiofrequency ablation for atrial fibrillation: a single-center retrospective study.}},
author = {Can Wu and Shaoping Zhu and Xing Chen and Jinping Liu},
journal = {Journal of thoracic disease},
year = {2026},
month = sep,
doi = {10.21037/jtd-2026-1856},
url = {https://europepmc.org/article/MED/42996970},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Clinical efficacy of minimally invasive cardiac valve surgery concomitant with radiofrequency ablation for atrial fibrillation: a single-center retrospective study.
AU - Can Wu
AU - Shaoping Zhu
AU - Xing Chen
AU - Jinping Liu
PY - 2026
DA - 2026/09/29
JO - Journal of thoracic disease
DO - 10.21037/jtd-2026-1856
UR - https://europepmc.org/article/MED/42996970
AB - Concomitant atrial fibrillation (AF) and valvular heart disease (VHD) present complex clinical challenges. Standard radiofrequency ablation (RFA) combined with valve surgery via median sternotomy offers robust rhythm correction but causes significant surgical trauma. Minimally invasive cardiac valve surgery with concomitant RFA (MICVS-RFA) is a promising strategy, but clinical data regarding its comprehensive safety, efficacy, and predictive risk factors for AF recurrence remain scarce. Thus, we aimed to evaluate the safety and clinical efficacy of MICVS-RFA and to develop an exploratory prognostic model for risk stratification. We retrospectively analyzed 146 patients with concomitant VHD and AF who underwent MICVS-RFA between April 1, 2020, and August 1, 2025. Surgical cohorts included mitral valve replacement (MVR; n=34), mitral valve repair (MVr; n=19), MVR combined with tricuspid valve repair (MVR + TVr; n=57), and MVr combined with tricuspid valve repair (MVr + TVr; n=36). Pre-operative predictors for post-operative AF recurrence were identified using least absolute shrinkage and selection operator (LASSO) and elastic net regularization integrated within a multiple imputation framework to develop an exploratory model. Left ventricular ejection fraction (LVEF) improvements were assessed dynamically. Procedural success was achieved in all 146 patients, with an overall 30-day freedom from recurrent AF (FFAF) rate of 89.7% and no observed major adverse events (stroke, bleeding, or thromboembolism) within the first post-operative month. Length of stay (LOS) showed no statistical differences among surgical cohorts (P=0.71). Logistic regression modeling identified pre-operative metoprolol usage as associated with lower odds of AF recurrence [odds ratio (OR) =0.17; 95% confidence interval (CI): 0.04-0.62], while pre-operative pulmonary hypertension (PH) showed a non-significant association with higher odds of AF recurrence (OR =3.07; 95% CI: 0.67-14.10). The predictive model showed moderate discrimination [bootstrap-corrected area under the receiver operating characteristic curve (AUC) =0.773] and apparent calibration. Patients with baseline LVEF <55% experienced superior functional recovery compared to those with LVEF ≥55% (ΔLVEF: 13.07%±2.56% vs. 0.18%±0.80%, P<0.001). MICVS-RFA was a feasible "dual minimally invasive" strategy that permits concomitant treatment of valvular pathology and AF through a minimally invasive approach, minimizing perioperative trauma. Comparative and long-term effects require further study.
SN - 2072-1439
SN - 2077-6624
ER -