RT-93
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Options for surgical treatment
of atrial fibrillation in patients with mitral valve disease
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Gaetano Minzioni, Marco Aiello,
Laura Ressia, Francesco Pagani, Mario Vigano.
Divisione e Cattedra di Cardiochirurgia, Policlinico San Matteo, Pavia, Italy
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Abstract
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Background. Atrial fibrillation (AF)
is the most common form of arrhythmia and is commonly associated with mitral valve
disease. Surgical treatment of the valve pathology has little effect on cardiac rhythm in
these patients, and AF recurs in most cases, leaving patients symptomatic even if the
valve disease is cured.
Method. Two different surgical options are available to the surgeon
to correct AF while operating on a mitral valve: the left atrial (LA) isolation and the
maze procedure. We operated on 335 patients with mitral valve disease and chronic AC:\WWW in
315 we performed a LA isolation (group 1) whereas in 20 a maze operation was done (group
2).
Results. Hospital mortality was 3.5% (11/315) in group 1 and 5%
(1/20) in group 2. Sinus rhythm (SR) was restored in the immediate postoperative period in
72% (227/315) in group 1 and in 70% (14/20) in group 2. After a mean follow-up of 46
months 82% (189/230) are in SR in group 1, and 76% (13/17) in group 2 where pacemaker
implantation was required in 4 patients. Among patients with LA isolation better results
were obtained by the patients who didn't have combined tricuspid surgery (76 vs 58%) (p
< 0.001). Haemodynamic study performed in 14 patients demonstrated a 13% increased
cardiac output in patients in SR and LA isolation when compared with the cardiac output of
the same patient without right atrial contribution.
Conclusions. AF in patients with mitral valve disease can be
surgically treated by combining the valve surgery with an anti-arrhythmic procedure. LA
isolation and maze operation are equally effective in restore SR in these patients, and
results are stable.
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Key Words
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Cardiac surgery – arrhythmias
atrial fibrillation, mitral valve disease, left atrial isolation, Maze operation, OA
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