To investigate the clinical efficacy and safety of heart valve surgery alone or simultaneously with atrial fibrillation radiofrequency ablation or further combined with left atrial appendage clipping in the prevention of cardiogenic stroke.

The clinical data of 45 patients with valvular heart disease complicated with atrial fibrillation treated at the Department of Thoracic Surgery of Linfen people's Hospital and the Department of Cardiac Surgery of Xi'an Xijing Hospital from March 2015 to August 2021 were analyzed retrospectively. There were 21 males and 24 females, with an average age of (62.3±7.7) years. There were 19 patients with permanent atrial fibrillation, 22 with persistent atrial fibrillation, and 4 with paroxysmal atrial fibrillation.

There was no death during the perioperative period. Eighteen cases underwent valve replacement alone, 12 underwent valve replacement+radiofrequency ablation, and 15 underwent valve replacement+radiofrequency ablation+left atrial appendage clipping. The average operation time of single valve replacement was (241.00±26.55) min, that of valve replacement+radiofrequency ablation was (275.50±12.69) min, and that of valve replacement+radiofrequency ablation+left atrial appendage clipping was (298.33±19.92) min. Thirty-six cases (4/5) had sinus rhythm immediately after operation, and 9 (1/5) had no sinus rhythm. The position of left atrial appendage clipping was good without displacement (15 cases, 100%). There were 1 case of postoperative stroke in the simple valve operation group and 1 case in the valve operation+radiofrequency ablation group. There was no stroke in the valve replacement+radiofrequency ablation+left atrial appendage clipping group. One patient each developed pleural effusion and bleeding in the simple valve operation group. In the valve operation+radiofrequency ablation group, there was 1 patient with bleeding after operation. There were no postoperative complications in the valve replacement+radiofrequency ablation+left atrial appendage clipping operation group.

Cardiac valve surgery combined with atrial fibrillation radiofrequency ablation and left atrial appendage clipping can significantly reduce the incidence of stroke. The incidence of postoperative complications is not affected by the increase of surgical complexity. The combination therapy is safe and efficient.