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Thorac Cardiovasc Surg 2016; 64(05): 441-446
DOI: 10.1055/s-0035-1558993
Original Cardiovascular
Georg Thieme Verlag KG Stuttgart · New York

Effect of Left Atrial Reduction on Restoration and Maintenance of Sinus Rhythm in Patients Undergoing Mitral Valve Replacement: A Pilot Study

Adnan Yalcinkaya
1   Turkey Yuksek Ihtisas Education and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
,
Adem Ilkay Diken
2   Hitit University Corum Education and Research Hospital, Department of Cardiovascular Surgery, Corum, Turkey
,
Eray Aksoy
3   Kartal Kosuyolu Education and Research Hospital, Department of Cardiovascular Surgery, Istanbul, Turkey
,
Gokhan Lafci
1   Turkey Yuksek Ihtisas Education and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
,
Omer Faruk Cicek
1   Turkey Yuksek Ihtisas Education and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
,
Ersin Kadirogullari
1   Turkey Yuksek Ihtisas Education and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
,
Umit Deniz Ulusar
4   Akdeniz University, Faculty of Engineering, Department of Computer Engineering, Antalya, Turkey
,
Kerim Cagli
1   Turkey Yuksek Ihtisas Education and Research Hospital, Department of Cardiovascular Surgery, Ankara, Turkey
› Author Affiliations
Further Information

Publication History

27 February 2015

12 June 2015

Publication Date:
20 August 2015 (online)

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Abstract

Background This pilot study aimed to evaluate the effectiveness of posterior left atrial wall plication (T-plasty) in patients with persistent atrial fibrillation (AF) (> 7 days) undergoing mitral valve surgery.

Materials and Methods A total of 60 patients who were scheduled for mitral valve replacement were randomly allocated into two groups: one would receive (Group 1; n = 32, mean age; 49.37 ± 9.00) and one would not receive (Group 2; n = 28; mean age 48.64 ± 8.6) left atrial size reduction using T-plasty technique. Patients with a clear indication for combined procedures other than tricuspid valve disease, aortic valve disease, and coronary artery stenosis were not included. Follow-up was performed at 6th, 12th, and 18th months after the operation.

Results After the operation, 21 patients (65.6%) in Group 1 and 13 patients (46.4%) in Group 2 regained sinus rhythm (p = 0.13). Mortality did not occur. AF recurrence rates were not significantly different between the groups in three follow-ups. Restoration of sinus rhythm was significantly more common in Group 1 patients than in Group 2 patients during follow-up. Patients in Group 1 had lower left atrial volume indexes than those in Group 2 at the 6th and 12th months, whereas the difference at the 18th month was at the limit of significance.

Conclusion We achieved satisfactory results using the T-plasty technique for left atrial size reduction in terms of mid-term restoration and preservation of normal sinus rhythm in patients undergoing mitral valve surgery. Further study may be justified to reveal the prognostic importance of the technique described herein.

Keywords

atrial fibrillation - left atrial enlargement - mitral valve replacement
 

  • References

  • 1 Sanfilippo AJ, Abascal VM, Sheehan M , et al. Atrial enlargement as a consequence of atrial fibrillation. A prospective echocardiographic study. Circulation 1990; 82 (3) 792-797
    CrossrefPubMedSearch in Google Scholar
  • 2 Bayes-Genis A, Vazquez R, Puig T , et al; MUSIC Study Group. Left atrial enlargement and NT-proBNP as predictors of sudden cardiac death in patients with heart failure. Eur J Heart Fail 2007; 9 (8) 802-807
    CrossrefPubMedSearch in Google Scholar
  • 3 Leung DY, Boyd A, Ng AA, Chi C, Thomas L. Echocardiographic evaluation of left atrial size and function: current understanding, pathophysiologic correlates, and prognostic implications. Am Heart J 2008; 156 (6) 1056-1064
    CrossrefPubMedSearch in Google Scholar
  • 4 Kizer JR, Bella JN, Palmieri V , et al. Left atrial diameter as an independent predictor of first clinical cardiovascular events in middle-aged and elderly adults: the Strong Heart Study (SHS). Am Heart J 2006; 151 (2) 412-418
    CrossrefPubMedSearch in Google Scholar
  • 5 Cho DK, Ha JW, Chang BC , et al. Factors determining early left atrial reverse remodeling after mitral valve surgery. Am J Cardiol 2008; 101 (3) 374-377
    CrossrefPubMedSearch in Google Scholar
  • 6 Henry WL, Morganroth J, Pearlman AS , et al. Relation between echocardiographically determined left atrial size and atrial fibrillation. Circulation 1976; 53 (2) 273-279
    CrossrefPubMedSearch in Google Scholar
  • 7 Kamata J, Kawazoe K, Izumoto H , et al. Predictors of sinus rhythm restoration after Cox maze procedure concomitant with other cardiac operations. Ann Thorac Surg 1997; 64 (2) 394-398
    CrossrefPubMedSearch in Google Scholar
  • 8 Kim YH, Lee SC, Her AY , et al. Preoperative left atrial volume index is a predictor of successful sinus rhythm restoration and maintenance after the maze operation. J Thorac Cardiovasc Surg 2007; 134 (2) 448-453
    CrossrefPubMedSearch in Google Scholar
  • 9 Marui A, Saji Y, Nishina T , et al. Impact of left atrial volume reduction concomitant with atrial fibrillation surgery on left atrial geometry and mechanical function. J Thorac Cardiovasc Surg 2008; 135 (6) 1297-1305
    CrossrefPubMedSearch in Google Scholar
  • 10 Apostolakis E, Shuhaiber JH. The surgical management of giant left atrium. Eur J Cardiothorac Surg 2008; 33 (2) 182-190
    CrossrefPubMedSearch in Google Scholar
  • 11 Dzemeshkevich S, Korolev S, Frolova J , et al. Isolated replacement of the mitral leaflets and “Mercedes”-plastics of the giant left atrium: surgery for patients with left ventricle dysfunction and left atrium enlargement. J Cardiovasc Surg (Torino) 2001; 42 (4) 505-508
    PubMedSearch in Google Scholar
  • 12 García-Villarreal OA, Rodríguez H, Treviño A, Gouveia AB, Argüero R. Left atrial reduction and mitral valve surgery: the “functional-anatomic unit” concept. Ann Thorac Surg 2001; 71 (3) 1044-1045
    CrossrefPubMedSearch in Google Scholar
  • 13 Minagoe S, Yoshikawa J, Yoshida K , et al. Obstruction of inferior vena caval orifice by giant left atrium in patients with mitral stenosis. A Doppler echocardiographic study from the right parasternal approach. Circulation 1992; 86 (1) 214-225
    CrossrefPubMedSearch in Google Scholar
  • 14 Matsuda H, Nakao M, Nohara H , et al. The causes of prolonged postoperative respiratory care in mitral valve disease with a giant left atrium [in Japanese]. Kyobu Geka 1990; 43 (3) 172-177 , discussion 177–182
    PubMedSearch in Google Scholar
  • 15 Sugiki H, Murashita T, Yasuda K, Doi H. Novel technique for volume reduction of giant left atrium: simple and effective “spiral resection” method. Ann Thorac Surg 2006; 81 (1) 378-380
    CrossrefPubMedSearch in Google Scholar
  • 16 Kawaguchi AT, Kosakai Y, Isobe F , et al. Surgical stratification of patients with atrial fibrillation secondary to organic cardiac lesions. Eur J Cardiothorac Surg 1996; 10 (11) 983-989 , discussion 989–990
    CrossrefPubMedSearch in Google Scholar
  • 17 Schuessler RB. Does size matter?. J Cardiovasc Electrophysiol 2001; 12 (8) 875-876
    CrossrefPubMedSearch in Google Scholar
  • 18 Kosakai Y. Treatment of atrial fibrillation using the Maze procedure: the Japanese experience. Semin Thorac Cardiovasc Surg 2000; 12 (1) 44-52
    CrossrefPubMedSearch in Google Scholar
  • 19 Özerdem G, Uymaz B, Sarıçam E , et al. Left atrial reduction by posterior wall plication combined with mitral valve surgery in patients with a dilated left atrium [in Turkish]. Turkish J Thorac Cardiovasc Surg 2011; 19: 311-316
    CrossrefPubMedSearch in Google Scholar
  • 20 Kawazoe K, Beppu S, Takahara Y , et al. Surgical treatment of giant left atrium combined with mitral valvular disease. Plication procedure for reduction of compression to the left ventricle, bronchus, and pulmonary parenchyma. J Thorac Cardiovasc Surg 1983; 85 (6) 885-892
    PubMedSearch in Google Scholar
  • 21 Piccoli GP, Massini C, Di Eusanio G , et al. Giant left atrium and mitral valve disease: early and late results of surgical treatment in 40 cases. J Cardiovasc Surg (Torino) 1984; 25 (4) 328-336
    PubMedSearch in Google Scholar
  • 22 Zheng SH, Sun YQ, Meng X, Gao F, Huang FH. Left atrial plication for left atrium associated with mitral valve disease [in Chinese]. Zhonghua Wai Ke Za Zhi 2005; 43 (14) 918-920
    PubMedSearch in Google Scholar
  • 23 Somerville W, Chambers RJ. systemic embolism in mitral stenosis: relation to the size of the left atrial appendix. BMJ 1964; 2 (5418) 1167-1169
    CrossrefPubMedSearch in Google Scholar
  • 24 Yuasa S, Soeda T, Masuyama S, Shimizu K, Matsuda M. Surgical treatment of giant left atrium using a combined superior-transseptal approach. Ann Thorac Surg 2003; 75 (6) 1985-1986
    CrossrefPubMedSearch in Google Scholar
  • 25 Pagel PS, Kehl F, Gare M, Hettrick DA, Kersten JR, Warltier DC. Mechanical function of the left atrium: new insights based on analysis of pressure-volume relations and Doppler echocardiography. Anesthesiology 2003; 98 (4) 975-994
    CrossrefPubMedSearch in Google Scholar
  • 26 Hagihara H, Kitamura S, Kawachi K , et al. Left atrial plication combined with mitral valve surgery in patients with a giant left atrium. Surg Today 1995; 25 (4) 338-342
    CrossrefPubMedSearch in Google Scholar