Key result
Sinus rhythm maintenance after mitral repair plus AF cryoablation is linked to ~21% lower LA volume.
Why the study?
The study was designed to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial outcomes after surgical AF cryoablation concomitant to minimally invasive mitral valve repair.
Does concomitant surgical AF cryoablation during minimally invasive mitral valve repair improve long-term left atrial morphology and function in patients with mitral valve disease and AF?
Observational (n=48)
No
Does concomitant surgical AF cryoablation during minimally invasive mitral valve repair improve long-term left atrial morphology and function in patients with mitral valve disease and AF?
Answers are grounded in this paper and cite their sources.
Concomitant AF cryoablation during minimally invasive mitral valve repair provides high rates of long-term sinus rhythm maintenance, which is associated with better preserved left atrial morphology and function compared to patients with AF relapses.
Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.
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Anselmino et al. (2019) conducted an observational in Mitral valve disease and atrial fibrillation (n=48). Stable sinus rhythm after minimally invasive mitral valve repair and concomitant AF cryoablation vs. Atrial fibrillation relapse was evaluated on Maximal left atrial volume indexed to body surface area (mL/mq) (p=0.008). Patients maintaining stable sinus rhythm after minimally invasive mitral valve repair and concomitant AF cryoablation had better maximal left atrial volume compared to those with AF relapses.
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