ObjectiveTo evaluate the safety and medium-to-long-term efficacy of Maze procedure with cryoablation in conjunction with mitral valve surgery for atrial functional mitral regurgitation (AFMR). MethodsRetrospective collection of clinical data from patients undergoing surgical treatment for AFMR in the Department of Cardiovascular Surgery at General Hospital of the Northern Theater Command from June 2013 to February 2022. Patients were divided into an ablation group and a non-ablation group based on whether they underwent ablation. Propensity score matching analysis was performed on the two groups with 15 parameters as covariates. The safety and medium-to-long-term efficacy of the operation in the two groups were compared. ResultsA total of 167 patients with AFMR were included, 95 of whom underwent isolated mitral valve surgery (non-ablation group), and 72 of whom underwent Maze procedure with cryoablation in conjunction with mitral valve surgery (ablation group). A total of 72 pairs were successfully matched. The ablation group included 33 males and 39 females, with an average age of (59.39±6.38) years; the non-ablation group included 33 males and 39 females, with an average age of (60.94±8.95) years. Within an average follow-up of 4 years, 4 deaths occurred in the ablation group, and 13 in the non-ablation group. The duration of extracorporeal circulation [(152.14±35.24) min vs. (93.63±32.48) min] and aortic cross-clamping time [(81.22±20.30) min vs. (47.26±17.89) min] were significantly longer in the ablation group compared to the non-ablation group (P<0.001), but there was no statistical difference in the incidence of perioperative adverse events between the two groups (P>0.05). The diameters of the left atrium and left ventricle were significantly reduced in both groups compared to pre-operation (P<0.05); the postoperative diameter of the left atrium [(47.82±6.72) mm vs. (51.58±8.63) mm] and left ventricular end-diastolic diameter [(47.46±5.06) mm vs. (49.61±6.64) mm] in the ablation group were significantly smaller than those in the non-ablation group, with statistical differences (P<0.05). At each follow-up time point, the sinus rhythm conversion rate and drug-free rate in the ablation group were significantly higher than those in the non-ablation group (P<0.001). Kaplan-Meier analysis showed that the cumulative survival rate in the ablation group (2 years: 98.6% vs. 89.9%; 4 years: 91.7% vs. 87.7%; 6 years: 91.7% vs. 73.9%, 8 years: 91.7% vs. 67.2%; P=0.026) and the rate of freedom from rehospitalization for heart failure (2 years: 98.3% vs. 86.7%; 4 years: 95.8% vs. 82.8%; 6 years: 90.1% vs. 74.9%; 8 years: 81.1% vs. 57.2%; P=0.031) were significantly higher than the non-ablation group. ConclusionConcomitant cryoablation Maze procedure with mitral valve surgery in treating patients with AFMR is safe and has satisfactory results. It can effectively promote the recovery of sinus rhythm, reverse adverse cardiac remodeling, and reduce the incidence of medium-to-long-term adverse events.