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Review
. 2025 Mar 27;37(2):4.
doi: 10.37616/2212-5043.1426. eCollection 2025.

Efficacy and Safety of Concomitant Surgical Ablation During Mitral Valve Replacement: A Systematic Review

Omar Hamodat #  1 , Saif Almuzainy #  1 , Rand Yahya  1 , Razan Alzaatreh  1 , Samiullah Haroon  1 , Salam Koniali  1
Affiliations
Review

Efficacy and Safety of Concomitant Surgical Ablation During Mitral Valve Replacement: A Systematic Review

Omar Hamodat et al. J Saudi Heart Assoc. .

Abstract

Objectives: Atrial fibrillation (AF) is a common comorbidity in patients undergoing mitral valve surgery (MVS), significantly increasing the risk of thromboembolism, heart failure, and mortality. Surgical ablation has recently been given a Class IA recommendation for concomitant MVS, reinforcing its role in restoring sinus rhythm and improving outcomes in this population. However, concerns about procedural complexity, extended operative time, and postoperative risks have limited its widespread adoption. This systematic review aims to synthesize evidence from recent randomized controlled trials to evaluate the safety and efficacy of surgical ablation for AF in patients undergoing MVS, addressing critical gaps in current clinical practice.

Methodology: We systematically searched Scopus, PubMed, and Ovid up to December of 2024 for randomized controlled trials (RCTs) that investigated surgical ablation concomitant to mitral valve repair or replacement (MVR) as the intervention, compared to isolated MVR.

Results: This review included 15 RCTs with 1219 patients (681 in the MVR + ablation group and 538 in the MVR-only group). Sinus rhythm restoration was significantly higher in the MVR + ablation group at discharge (64.7% vs. 18.8%), 6 months (62.5% vs. 22.4%), and 1 year (66.0% vs. 25.7%), indicating both immediate and sustained benefits. Short-term mortality rates were similar between groups (2.2% vs. 1.97%), while 1-year mortality was lower in the MVR + ablation group (5.43% vs. 5.91%). Pacemaker implantation rates were slightly higher in the MVR + ablation group, while stroke and thromboembolic events were rare and comparable between groups.

Conclusion: Surgical ablation combined with mitral valve surgery significantly improves sinus rhythm outcomes. While stroke and short-term mortality remain comparable between groups, one-year mortality was lower in the ablation group, warranting further investigation. Additionally, the increased pacemaker implantation rate in specific populations warrants tailored approaches.

Keywords: Atrial fibrillation; Mitral valve surgery; RCT; Sinus rhythm; Surgical ablation.

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Conflict of interest statement

Conflict of interest: The authors of this study declare no conflict of interest.

Figures

Fig. 1
Fig. 1
PRISMA study flow diagram.
Fig. 2
Fig. 2
ROB 1 quality assessment of the included studies.
See this image and copyright information in PMC

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