Key result
Cardiac autotransplantation in patients with mitral valve disease and permanent atrial fibrillation resulted in 89.7% of patients maintaining sinus rhythm at a mean follow-up of 21.1 months.
Why the study?
Does cardiac autotransplantation effectively treat permanent atrial fibrillation and reduce left atrial volume in patients undergoing mitral valve surgery?
Observational (n=30)
Does cardiac autotransplantation effectively treat permanent atrial fibrillation and reduce left atrial volume in patients undergoing mitral valve surgery?
May support autotransplantation for sinus restoration in enlarged atria during mitral surgery; hypothesis-generating and requires randomized confirmation.
OBJECTIVES: The results of current surgical options for the treatment of permanent atrial fibrillation (AF) associated with mitral surgery are widely different, particularly in very enlarged left atria. The aim of this study was to assess the mid-term efficacy of cardiac autotransplantation for this goal, through a consistent reduction of left atrium volume and a complete isolation of the pulmonary veins. METHODS: From April 2000 to September 2002, 30 patients (male/female 5/25) underwent cardiac autotransplantation for the treatment of mitral valve disease and concomitant permanent AF (>1 year). Surgical technique of bicaval heart transplantation was modified maintaining the connection of inferior vena cava in all but three cases. Twenty-eight patients had mitral valve replacement and two had mitral valve repair. Associated procedures were: aortic valve replacement (6 cases), tricuspid valve repair (2 cases), coronary re-vascularization (2 cases) and right atrium volume reduction (4 cases). RESULTS: No hospital death occurred; 1 patient died 3 months post-operatively for pneumonia. At a mean follow-up of 21.1+/-7.7 months (range 6-35), 26 patients (89.7%) were in sinus rhythm and 3 (10.3%) in AF. Santa Cruz Score was 0 in 3 patients, 2 in 2 patients and 4 in the remaining 24 patients (82.7%). Mean left atrial diameter and volume decreased from 65.1+/-16.4 mm (range 50-130 mm) to 49.9+/-8.4 mm (range 37-78) (P < 0.001) and from 118.3+/-68.4 ml (range 60-426) to 69.4+/-34.1 ml (range 31-226) (P = 0.001), respectively, after the operation. CONCLUSIONS: Cardiac autotransplantation is a safe and effective option for the treatment of permanent AF in patients with mitral valve disease and severe dilation of left atrium.
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Troise et al. (2004) conducted an observational in Mitral valve disease and permanent atrial fibrillation (n=30). Cardiac autotransplantation was evaluated on Sinus rhythm at follow-up. Cardiac autotransplantation in patients with mitral valve disease and permanent atrial fibrillation resulted in 89.7% of patients maintaining sinus rhythm at a mean follow-up of 21.1 months.
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