Left atrial reduction in modified maze procedure with concomitant mitral surgery

Kasemsarn, Choosak; Lerdsomboon, Piyawat; Sungkahaphong, Vibhan; Chotivatanapong, Taweesak

doi:10.1177/0218492313492438

Cited by 10 publications

(15 citation statements)

References 20 publications

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“…Chen et al ( 20 ) showed that the sinus conversion rate was significantly lower in patients with preoperative LA diameters >56.8 mm (p<0.001) or AF duration >66 months (p<0.001). Kasemsarn et al ( 21 ) revealed that RFA was an effective option for treatment of permanent AF concomitant with MV surgery and atrial reduction to <50 mm in improving SR restoration rates.…”

Section: Discussionmentioning

confidence: 99%

Early and long-term outcomes and quality of life after concomitant mitral valve surgery, left atrial size reduction, and radiofrequency surgical ablation of atrial fibrillation

Joshibayev¹,

Болатбеков

2016

Anatol J Cardiol

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Objective:Atrial fibrillation (AF) is the most formidable supraventricular tachyarrhythmia, which worsens the natural course of mitral valve disease. In this study, we evaluated early and long-term results and quality of life (QOL) after simultaneous surgical radiofrequency ablation (RFA) of AF, left atrial reduction and mitral valve repair or replacement.Methods:Overall, 147 patients with mitral valve diseases who underwent mitral valve surgery were included in this prospective cohort study. Patients were divided into two groups according to the type of operation: the study group—patients after mitral valve surgery with concomitant radiofrequency surgical ablation and left atrial reduction procedure (54 patients), and the control group—patients undergoing only mitral valve surgery (93 cases). We assessed AF recurrence and sinus rhythm restoration rates and mortality rates, QOL measures, postoperative complications rates, and left atrial size during follow-up.Results:In the study group, sinus rhythm restoration rate in the early postoperative period was 63%, but at the time of discharge it reduced to 29%; after 6 months, it significantly increased to 72% and after 3 years, to 81% (p=0.02). In the control group, the sinus rhythm restored only in 14% after 1 year, and at 3 years, it was 22%, although in the early postoperative period it, was 43%. Analysis of left atrial size before and after surgery showed that dimension significantly reduced in both groups (study group, p=0.013; control group, p=0.024). In addition, in patients undergoing surgical RFA procedure, there was a significant association between shorter heart disease history (p=0.02) and shorter AF history (p=0.074) with maintenance of sinus rhythm. The mortality rate in the study group was 4% (two patients) and in the control group 5% (five patients). Comparison of QOL measures between study and control groups after 1 year showed that patients undergoing concomitant atrial reduction surgery and RFA had significant improvement of QOL physical (p=0.03) and role (p=0.03) functioning, heartbeat (p=0.01), general (p=0.03) and mental health (p=0.01), vitality (p=0.007), and social role (p=0.02) functioning measures as compared to preoperative state, being higher than in patients who underwent only mitral valve surgery.Conclusion:Application of surgical RFA using irrigated cooling electrode and atrial reduction during mitral valve surgery is associated with higher restoration and maintenance of SR as compared to patients undergoing only mitral valve surgery. We did not observe complications related to AF surgery that required permanent pacemaker implantation. Performing concomitant surgery as surgical RFA, atrial reduction along with mitral valve surgery, improves QOL in the short- and long-term and reduces the feeling of heartbeat and discomfort. (Anatol J Cardiol 2016; 16: 797-803)

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Section: Discussionmentioning

confidence: 99%

Early and long-term outcomes and quality of life after concomitant mitral valve surgery, left atrial size reduction, and radiofrequency surgical ablation of atrial fibrillation

Joshibayev¹,

Болатбеков

2016

Anatol J Cardiol

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“…Chen [12] показал, что конверсия синусового ритма была значительно ниже у пациентов с предоперационным размером ЛП больше 56,8 мм или продолжительностью ФП более 66 мес. C. Kasemsarn [13] также выявил, что РЧА была эффективным вариантом лечения ФП при одновременной коррекции митрального клапана только в случае, если размер ЛА составлял менее 50 мм.…”

Section: Discussionunclassified

One-Stage Application of Mitral Valve Correction, Surgical Radiofrequency Ablation and Left Atrial Atrioplasty

Sd¹,

Bolatbekov

2015

ARAMS

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One-Stage Application of Mitral Valve Correction, Surgical Radiofrequency Ablation and Left Atrial Atrioplasty Objective: Our aim was to evaluate sinus rhythm restoration and its failure predictors after one-stage application of surgical radiofrequency ablation, left atrial reduction and mitral valve correction. Methods: This is a prospective longitudinal cohort study with historical controls. Patients were divided into 2 groups according to the performed type of operation-the main group included patients undergone one-stage mitral valve correction, surgical radiofrequency ablation and left atrial atrioplasty (n =47); and the control group consisted of patients undergone only mitral valve correction (n =76). Surgical radiofrequency ablation was performed under the scheme Maze-IV. Left atrial atrioplasty procedure was performed according to echocardiography data: if in women LA antero-posterior dimensions were more than 4.7 cm and in men more than 5.2 cm. Results: The study included 123 patients. In the main group (age of the patients 61.0±9.1 years, 55% male) sinus rhythm restoration was observed in 32 (68%) patients during the early postoperative period, but at the time of discharge it reduced to 19 (40%), but in 6 months it increased up to 37 (78%), and in 36 months sinus rhythm already was detected in 40 (85%) patients. At the same time, during the early postoperative period in the control group (patients aged 59.0±11.0 years, 61% male) only 31 (40%) of patients had sinus rhythm, in 6 months it was detected in 11 (14%) cases, and in 36 months sinus rhythm-only in 28 (37%) patients. Predictors of atrial fibrillation recurrence were revealed: valve disease continuance <4 years (p =0.017) and atrial fibrillation history <3 years (p =0.029). Conclusion: One-stage performing of mitral valve correction, surgical radiofrequency ablation and left atrial atrioplasty restores and maintains more regular sinus rhythm, even in presence of atrial fibrillation recurrence predictors.

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“… 22 , 24 The dilatation of the LA is one of the predictors of the modified Maze procedure; in a cohort of patients undergoing operation for AF, Kawaguchi and colleagues 26 demonstrated that those remaining in AF (vs patients with restored SR) had a significantly higher incidence of GLA and larger cardiothoracic ratio and LA dimension; most patients with postoperative LA size less than 40 mm or cardiothoracic ratio less than 55% had restored SR. Kim and colleagues 25 found that LA volume reduction and cryoablation instead of radiofrequency were protective against AF recurrence during surgical ablation of AF. Kasemsarn and colleagues 27 reported that reducing the LA diameter to less than 50 mm increases the success of conversion to SR in patients undergoing radiofrequency ablation. In our series, only 35% of patients maintained SR during extended follow-up; afterward, we considered that our technique alone did not have enough effect over this end point.…”

Section: Discussionmentioning

confidence: 99%

A new surgical technique for left atrial reduction in giant left atrium

Ríos-Ortega¹,

Talledo-Paredes²,

Yepez-Calderón³

et al. 2023

JTCVS Techniques

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Left atrial reduction in modified maze procedure with concomitant mitral surgery

Abstract: Radiofrequency ablation is an effective option for treatment of permanent atrial fibrillation concomitant with mitral valve surgery. Atrial reduction to <50 mm improves success. Elimination of atrial fibrillation significantly prolongs patient survival.

Cited by 10 publications

References 20 publications

Early and long-term outcomes and quality of life after concomitant mitral valve surgery, left atrial size reduction, and radiofrequency surgical ablation of atrial fibrillation

Early and long-term outcomes and quality of life after concomitant mitral valve surgery, left atrial size reduction, and radiofrequency surgical ablation of atrial fibrillation

One-Stage Application of Mitral Valve Correction, Surgical Radiofrequency Ablation and Left Atrial Atrioplasty

A new surgical technique for left atrial reduction in giant left atrium

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