Key result
Left atrial reduction during mitral valve surgery was associated with a higher rate of sinus rhythm upon discharge compared to surgery without reduction (62% vs 16%).
Why the study?
To evaluate the immediate results of left atrial reduction during correction of mitral valve disease complicated by left atrial enlargement.
Does left atrial reduction during mitral valve surgery improve postoperative outcomes and restore sinus rhythm in patients with mitral valve disease and left atrial enlargement?
Cohort (n=144)
Does left atrial reduction during mitral valve surgery improve postoperative outcomes and restore sinus rhythm in patients with mitral valve disease and left atrial enlargement?
Left atrial reduction during mitral valve surgery effectively decreases left atrial volume and significantly improves the restoration of sinus rhythm upon discharge.
May support left atrial reduction adjunct in enlarged atria during mitral surgery; leaves open need for randomized confirmation.
Objective. To evaluate the immediate results of left atrial reduction in correction of mitral valve disease complicated by left atrial enlargement. Material and methods. A retrospective analysis of surgical treatment included 100 patients (48 men and 52 women, mean age 69.9±11.1) who underwent left atrial reduction (main group) between 2013 and 2023. Preoperative left atrial volume was 334±235 ml (200—1430). For detailed analysis, the main group was divided into two subgroups: baseline left atrium volume <300 ml (64 (64%) patients) and >300 ml (36 (36%) patients). The control group included 44 patients (23 men and 21 women, mean age 60.2±10.3 years), who underwent mitral valve surgery without left atrial reduction. Preoperative left atrial volume in the control group was 248 ml (200—550). Results. In-hospital mortality in the main group was 2%. Postoperative left atrium volume in the main group was 111±76.3 ml. Upon discharge, sinus rhythm was recorded in 61 patients (62%). In 11 patients, baseline sinus rhythm was stable after surgery. In 50 (51%) patients, sinus rhythm was restored. Among 55 patients after additional radiofrequency Cox Maze IV procedure, stable sinus rhythm was observed in 43 (78%) cases. There were no deaths in the control group. Left atrium volume decreased from 248 (220—315) to 200 (180—240) ml. Sinus rhythm was maintained or restored in 7 (16%) patients. When analyzing the correlation of sinus rhythm recovery after surgery with baseline left atrium volume and duration of atrial fibrillation, we found that the most frequent restoration of sinus rhythm was observed in patients with baseline left atrium volume <400 ml and duration of atrial fibrillation <20 months. Conclusion. Left atrial reduction improves postoperative outcomes in this complex group of patients. Correction of heart valve disease and left atrial reduction are effective to restore sinus rhythm.
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Podchasov et al. (2025) conducted a cohort in Mitral valve disease complicated by left atrial enlargement (n=144). Left atrial reduction vs. Mitral valve surgery without left atrial reduction was evaluated on Sinus rhythm upon discharge. Left atrial reduction during mitral valve surgery was associated with a higher rate of sinus rhythm upon discharge compared to surgery without reduction (62% vs 16%).
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