|
Atrial fibrillation is an accompaining disorder
in advanced mitral disease. The spontaneous recovery of sinus rythm after simple
repair or replacement of the mitral valve is very rare and therefore several attempts
have been made to design adjuntive surgical procedures in order to acheive this goal.
Based on electrophysiological and anatomical considerations, in the recent years two
methods have gained diffuse popularity: the left atrial isolation and the maze
procedure. The advantages of the former are the easy and fast performance with an
high rate of success. The maze procedure is a long and cumbersome operation with a
significant rate of potential complications but, togheter with very interesting results in
terms of sinus rythm restoration, it allows the recovery of the atrial contractility. Due to
the anatomo-functional superiority of the latter procedure, the efforts are devoted to the
reduction of its adverse effects, mainly the lenght and invasiveness. The replacement
of the surgical incisions with radiofrequency is time saving and bleeding free. The
authors report their experience with this modification and the results are comparable
with those obtained with the original maze procedure. Analyzing the various
experiences reported in the literature, the successful rate in restoring the sinus rythm
depends on the conditions of the left atrium (volume, mass, calcifications), the right
atrium (dilatation) and on the surgical procedure. Further investigations are required in
order to optimize the “tailoring” of the approach in the various situations.
|
