Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: A comparative study with propensity score matching from a single-centre

Abstract Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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Efficacy, safety, and long-term survival of concomitant valve replacement and bipolar radiofrequency ablation in patients aged 70 years and older: a comparative study with propensity score matching from a single-Centre

Journal of Cardiothoracic Surgery ◽

10.1186/s13019-020-01322-9 ◽

2020 ◽

Vol 15 (1) ◽

Author(s):

Zhi-qin Lin ◽

Zeng-rong Luo ◽

Qian-zhen Li ◽

Liang-wan Chen ◽

Feng Lin

Keyword(s):

Radiofrequency Ablation ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Valve Replacement ◽

Single Centre ◽

Term Survival ◽

Long Term Survival ◽

Bipolar Radiofrequency

Abstracts Background Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. In the current study, we aimed to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF). Methods This was a retrospective study of patients aged ≥70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-centre between January 2006 and March 2015. The early postoperative results and long-term clinical outcomes were compared after propensity score matching. Results A total of 34 pairs of patients (73.94 ± 2.64 years old; 34 in the AF with ablation group and 34 in the AF without ablation group) were enrolled in the propensity score matching analysis. There were no significant differences between the two matched groups in terms of surgical mortality (5.88% vs. 2.94%, P = 0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival in the AF with ablation group compared to the AF without ablation group (P = 0.009). Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF with ablation group (P = 0.025, Gray’s test). Patients in the AF with ablation group had a reduced incidence of stroke compared to patients in the AF with ablation group (P = 0.009, Gray’s test). The freedom from AF after 5 years was 58.0% in the AF with ablation group and 3.0% in the AF without ablation group. Conclusions The addition of bipolar radiofrequency ablation is a safe and feasible procedure, even in patients aged ≥70 years, with a better long-term survival and a reduced incidence of stroke compared to valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF who require cardiac surgery. However, a large-scale, prospective, multi-centre, randomized study should be performed in the future to fully validate our findings.

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Efficacy, Safety, and Long-term Survival of Concomitant Valve Replacement and Bipolar Radiofrequency Ablation in Patients Aged 70 Years and Older: A Comparative Study With Propensity Score Matching From a Single-Center

10.21203/rs.3.rs-35598/v1 ◽

2020 ◽

Author(s):

Zhi-qin Lin ◽

Zeng-rong Luo ◽

Qian-zhen Li ◽

Liang-wan Chen ◽

feng lin

Keyword(s):

Radiofrequency Ablation ◽

Propensity Score ◽

Elderly Patients ◽

Propensity Score Matching ◽

Valve Replacement ◽

Untreated Group ◽

Single Center ◽

Term Survival ◽

Bipolar Radiofrequency

Abstract Background: Concomitant bipolar radiofrequency ablation and valve replacement in the elderly remains controversial. We aim to compare the outcomes of concomitant valve replacement and bipolar radiofrequency ablation with valve replacement alone in elderly patients with atrial fibrillation (AF).Methods: This was a retrospective study of patients aged ≥ 70 years who underwent valve replacement with or without bipolar radiofrequency ablation in a single-center between January 2006 and March 2015. Early postoperative results and long-term clinical outcomes were compared after propensity score matching.Results: 34 pairs of patients (73.94±2,64 years old, 34 in the AF ablated group and 34 in the AF untreated group) were enrolled in the propensity score matching analysis. No significant differences between the two matched groups were found about surgical mortality (5.88% vs. 2.94%, P=0.555) and major postoperative morbidity. Kaplan–Meier analysis revealed a significantly better overall survival (P=0.009) in the AF ablated group. Cumulative incidence curves showed a lower incidence of cardiovascular death in the AF ablated group (P=0.025, Gray’s test). Patients in the AF ablated group had a reduced incidence of stroke events compared with patients in the AF untreated group (P=0.009, Gray’s test). Freedom from AF after 5 years was 58.0% in the AF ablated group, compared with 3.0% in the AF untreated group.Conclusions: The addition of bipolar radiofrequency ablation is a feasible and safe procedure even in patients aged ≥ 70 years, with a better long-term survival and a reduced incidence of stroke events compared with valve replacement alone. These findings suggest that bipolar radiofrequency ablation should always be considered as a concomitant procedure for elderly patients with AF presenting for cardiac surgery.

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Comparison of Long-term outcomes between Lynch sydrome and sporadic colorectal cancer: a propensity score matching analysis

10.21203/rs.3.rs-130271/v1 ◽

2020 ◽

Author(s):

Yun Xu ◽

Cong Li ◽

Charlie Zhi-Lin Zheng ◽

Yu-Qin Zhang ◽

Tian-An Guo ◽

...

Keyword(s):

Colorectal Cancer ◽

Propensity Score ◽

Propensity Score Matching ◽

Control Group ◽

Sporadic Colorectal Cancer ◽

Long Term Outcomes ◽

Term Survival ◽

Long Term Survival ◽

Tumor Stages

Abstract Background Lynch syndrome (LS) is the most common hereditary colorectal cancer (CRC) syndrome. Comparison of prognosis between LS and sporadic CRC (SCRC) were rare,with conflicting results. This study aimed to compare the long-term outcomes between patients with LS and SCRC. Methods Between June 2008 and September 2018, a total of 47 patients were diagnosed with LS by genetic testing at Fudan University Shanghai Cancer Center. A 1:2 propensity score matching was performed to obtain homogeneous cohorts from SCRC group. Thereafter, 94 SCRC patients were enrolled as control group. The long-term survival rates between the two groups were compared, and the prognostic factors were also analyzed. Results The 5-year OS rate of LS group was 97.6%, which was significantly higher than of 82.6% for SCRC group (p = 0.029). The 5-year PFS rate showed no significant differences between the two groups (78.0% for LS group vs. 70.6% for SCRC patients; p = 0.262). The 5-year TFS rates in LS group was 62.1% for LS patients, which were significantly lower than of 70.6% for SCRC group (p = 0.039). By multivariate analysis, we found that tumor progression of primary CRC and TNM staging were independent risk factors for OS. Conclusion LS patients have better long-term survival prognosis than SCRC patients. Strict regular follow-up monitoring, detection at earlier tumor stages, and effective treatment are key to ensuring better long-term prognosis.

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