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

BackgroundThis 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 ResultsBetween 1994 and 2014, 1568 consecutive patients withAFundergoing mitral valve procedure were identified. In 26.0% (n=408), surgical ablation ofAFwas used. Propensity‐score matching (PSM) was performed on the basis of 41 known perioperative risk variables. Survival, reoperation, stroke, and moderate‐to‐severeTR, 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‐severeTR(HR, 1.436; 95%CI, 1.059–1.948;P=0.020), associated with a significantly deteriorated cardiac function, progression ofTR, and right‐sided heart remodeling after 5‐year follow‐up. In a subgroup comparison of ablated patients with sinus rhythm versusAFrecurrence, aPSManalysis was performed at the 5‐year follow‐up. The recurrent group showed significantly higher risks of moderate‐to‐severeTR(HR, 2.427; 95%CI, 1.261–4.671;P=0.008).AFrecurrence was associated with progressiveTRand significant deterioration in right‐sided heart remodeling.ConclusionsIn a retrospectivePSManalysis, mitral valve disease withAFwas associated withTRprogression as well as right‐sided heart remodeling, which are alleviated by surgical ablation.