Hybrid PCI followed by surgical valve repair or replacement has been reported favor- ably but is restricted to patients at high risk with a combined surgical approach.20 14.2. Intervention for AF in Patients With VHD Recommendations for Intervention for AF in Patients With VHD Referenced studies that support the recommendations are summarized in Online Data Supplement 46. COR LOE Recommendations In patients with VHD and AF for whom surgical intervention is planned, the potential symptomatic benefits and additional procedural risks of adjunctive arrhythmia surgery at the time of cardiac valvular surgery should be discussed with the patient.1 11 For symptomatic patients with paroxysmal or persistent AF who are undergoing valvular surgery, surgical pulmonary vein isolation or a maze procedure can be beneficial to reduce symptoms and prevent recurrent For patients with AF or atrial flutter who are undergoing valve surgery, LA appendage ligation/excision is reasonable to reduce the risk of thromboembolic events.16 19 In patients undergoing LA surgical ablation of atrial arrhythmias and/or LA appendage ligation/excision, anticoagulation therapy is reasonable for at least 3 months after the 3: Harm B-NR For patients without atrial arrhythmias who are undergoing valvular surgery, LA appendage occlusion/exclusion/amputation is potentially Synopsis For patients undergoing valve surgery with symptom- atic AF or atrial flutter, concomitant maze procedure with or without atrial appendage occlusion/exclusion/ amputation is a proven treatment for the atrial arrhyth- mia but requires postoperative anticoagulation for at least 3 months after the procedure (Figure 20). Recommendation-Specific Supportive Text 1. 