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Surgical Treatment of Atrial Fibrillation Restores Expected Survival in Patients Undergoing Valvular Heart Surgery *Richard Lee, Muthiah Vaduganathan, Edward Wang, Jane Kruse, *Edwin C McGee, Jr., *S C Malaisrie, Robert O Bonow, Patrick M McCarthyBluhm Cardiovascular Institute, Division of Cardiothoracic Surgery at Northwestern University, Feinberg School of Medicine and Northwestern Memorial Hospital, Chicago, IL Objectives. Previous studies have established that patients undergoing valvular heart surgery with a history of atrial fibrillation (AF) have worse long-term prognoses compared to patients without AF. It is not clear if surgical correction of AF attenuates this increased risk of mortality. Thus, we sought to compare the long-term survival of patients with treated AF to patients without a history of AF. Methods. We evaluated 3056 consecutive patients undergoing cardiac surgery at a single institution from April 2004 to April 2009. Of these patients, 530 (17.3%) had AF that was treated with the Maze procedure. Propensity scores were calculated based on 37 known pre-operative risk factors (demographics, clinical and surgical characteristics, valve pathology and medications). Patients with surgically corrected AF (n=372) were propensity matched to patients without a history of AF (n=372) and long-term survival was compared between the two groups. The number of patients with untreated AF (n=164) was insufficient for propensity matched analysis. Using the matched sample (n=744), subset analysis was also performed to compare outcomes in patients who had isolated aortic valve replacement (AVR) (n=373, 46.0%), mitral valve repair or replacement (MVR) (n=221, 27.3%) and concomitant coronary artery bypass and a valve intervention (CABG-Valve) (n=171, 21.1%). Results. Mean follow-up was 2.2 years. In the unmatched analysis, maze-treated AF patients had significantly improved rates of all-cause mortality compared to untreated AF patients [58(10.9%) vs. 37(22.6%), P=0.0002]. In matched patients undergoing cardiac surgery, patients with surgically treated AF have similar mortality rates as compared to patients without a history of AF [33(8.9%) vs. 28(7.5%), P=0.50]. Survival analysis showed no early or late differences between the two groups [log-rank P=0.59, see Figure]. Patients with treated AF also had similar 30-day stroke rates [12(3.2%) vs. 18(4.8%), P=0.26] and total length of stay [10.1±10 vs. 10.9±12 days, P=0.31] compared to patients without AF. Subset analysis confirmed that survival was not different between the two groups in patients undergoing isolated AVR [P=0.66], isolated MVR [P=0.45] and CABG-Valve [P=0.20]. Conclusions. Treating AF in patients undergoing valve surgery restores the expected survival to that of patients without preexisting AF, irrespective of the surgical procedure. Strong consideration should be given to the treatment of AF in this population. 
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