Concomitant atrial fibrillation ablation during aortic valve and aneurysm surgery.

Objective: Limited data are available on treatment of atrial fibrillation during ascending aortic aneurysm and aortic valve surgery. Ablation at the time of isolated aortic valve surgery has a Society of Thoracic Surgeons Class I indication. We sought to determine early and late outcomes of concomitant atrial fibrillation surgery at the time of ascending aortic aneurysm + aortic valve surgery. Methods: From July 2008 to June 2023, patients undergoing elective ascending aortic aneurysm + aortic valve surgery ± atrial fibrillation surgery were compared. Clinical follow-up was conducted annually (median 5.6 [3.1-9.2] years). Results: Of 792 patients in the cohort, 89 (11.2%) had preoperative atrial fibrillation and all underwent atrial fibrillation ablation procedures: pulmonary vein isolation (42.7%), left atrial cryoablation (19.1%), and biatrial cryoablation (38.2%). After 2:1 propensity score matching between the no atrial fibrillation (123) and ablation groups (67), postoperative complications were pacemaker implant (1.7% vs 1.6%; Conclusions: For patients undergoing aneurysm surgery concomitantly with aortic valve surgery, surgical ablation was effective and did not increase 30-day mortality. Survival and stroke outcomes were similar to a matched reference group without preoperative atrial fibrillation. Ablation of atrial fibrillation should be considered at the time of aortic surgery.