Long-term outcomes of concomitant left-sided cryoablation during totally endoscopic mitral valve surgery.

Objectives: Concomitant atrial fibrillation ablation is a well-established procedure in patients undergoing mitral valve surgery. However, data concerning the long-term outcomes of cryoablation performed during totally endoscopic mitral valve surgery remain limited. Furthermore, different lesion sets and energy sources used in endoscopic approach may result in varying outcomes. We therefore, analyzed rhythm outcome in patients undergoing left-sided cryoablation during totally endoscopic mitral valve surgery.

Methods: Patients, who underwent totally-endoscopic mitral valve surgery with concomitant left-sided cryoablation between 2016 and 2023 at our center were included in the study. The retrospective data analysis was based on 24-hour Holter monitor follow-up data.

Results: A total of 123 patients were included in the study. No complications related to the ablation procedure were observed. The median follow-up period was 36.0 (interquartile range: 17-60) months. During this period, 34 episodes of atrial fibrillation recurrence were documented, corresponding to a recurrence rate of 8.43 per 100 patient-years (95% confidence interval: 5.90 to 11.73). The estimated freedom from AF at 1, 3, and 5 years were 96.6%, 86.3% and 69.4% respectively. Type of atrial fibrillation (p = 0.004; hazard ratio [HR]: 2.521; 95% confidence interval [CI]: 1.347-4.716) and left atrial volume (p = 0.003; HR: 1.010; 95% CI: 1.003-1.016) were identified as predictors for atrial fibrillation recurrence.

Conclusions: Concomitant left-sided cryoablation during totally endoscopic mitral valve surgery is a safe and effective procedure for atrial fibrillation treatment. The encouraging long-term outcomes support the conside ration of this approach in totally endoscopic mitral surgery.