Partial Cardiac Autotransplantation for Reduction of the Left Atrium

Abstract

Various surgical procedures have been employed to treat a greatly enlarged left atrium. We review the use of partial cardiac autotransplantation to reduce left atrial volume in 7 patients with rheumatic mitral valve disease and left atrial and ventricular volume in 2 patients with idiopathic dilated cardiomyopathy. There were 5 males and 4 females aged 25 to 62 years. The patients with rheumatic etiology had atrial fibrillation, while those with dilated cardiomyopathy had sinus rhythm. The mitral valve was replaced in 6 patients and reconstructed in 3. Mean aortic cross clamp time in the operations involving isolated left atrial resection was 119 +/- 44 min. Mean left atrial volume fell from 331 mL to 92 mL, while mean left atrial diameter decreased from 8.6 cm to 4.7 cm. Sinus rhythm was restored in 5 of the 7 patients who had preoperative atrial fibrillation. There was no operative mortality. The patients with dilated cardiomyopathy died in the postoperative period, one on the 14th day from low cardiac output and the other on the 113th day from multiorgan failure. Partial cardiac autotransplantation can be effective in reducing heart chamber size in selected patients, especially those with giant left atrium.

A study to assess the impact of left atrial size reduction in outcome of the patients undergoing mitral valve surgery for mitral valve disease with left atrial enlargement in a tertiary care hospital

“…18,19 Erdogan et al reported similar findings of improvement pre operatively from NYHA functional class III (65%), and 35% were in class II to NYHA class I at six months on follow up. 20 AF usually accompanies MV disease at the time of surgery, especially when the LA is enlarged. This is the main determining factor in the occurrence and maintenance of chronic AF.…”

Partial cardiac autotransplantation with a concomitant mitral valve, aortic valve replacement and tricuspid plasty

“…My teacher, Arrigo Lessana in Aubervilliers, France, had begun to use partial cardiac autotransplantation in the spring of 1998 [2] for adequate visualization to reduce the size of the left atrium (LA). Later, when I came back to Mexico, I operated on three cases of mitral valve disease and chronic atrial fibrillation (AF) with giant LA from 2000 to 2001 [3]. All three cases had a spectacular outcome.…”

“…Then, the left atrium was closed using running 5-0 polypropylene sutures ( Fig. 1) [3]. Finally, through a vertical right atriotomy, a tricuspid annuloplasty was performed with an Edwards MC 3 tricuspid annuloplasty ring (Edwards Lifesciences, Irvine, CA, USA).…”

“…Because GLA can increase the risk of sudden death, its existence merits careful evaluation and surgical intervention when needed [1,2]. Cardiac autotransplantation has been recommended to achieve left atrium volume reduction and relief of compressive symptoms after surgery [3,4]. We describe here a patient with a GLA who had successful surgical correction by partial heart autotransplantation.…”

Circumferential Left Atrium Resection for Treating a Giant Left Atrium

“…Cardiac autotransplantation for LA size reduction in patients with AF was designed to obtain significant reduction of LA size, an excellent exposure of the mitral valve, and complete exclusion of AF wavelets around the pulmonic veins. However, due to the aggressiveness and risk of bleeding, reports using this technique are rare …”