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The Annals of Thoracic Surgery, Vol 54, 1093-1097, Copyright © 1992 by The Society of Thoracic Surgeons
A Graffigna, F Pagani, G Minzioni, J Salerno and M Vigano
Surgical isolation of the left atrium was performed for the treatment of
chronic atrial fibrillation secondary to valvular disease in 100 patients
who underwent mitral valve operations. From May 1989 to September 1991, 62
patients underwent mitral valve operations (group I); 19, mitral valve
operations and DeVega tricuspid annuloplasty (group II); 15, mitral and
aortic operations (group III); and 4, mitral and aortic operations and
DeVega tricuspid annuloplasty (group IV). Left atrial isolation was
performed, prolonging the usual left paraseptal atriotomy toward the left
fibrous trigone anteriorly and the posteromedial commissure posteriorly.
The incision was conducted a few millimeters apart from the mitral valve
annulus, and cryolesions were placed at the edges to ensure complete
electrophysiological isolation of the left atrium. Operative mortality
accounted for 3 patients (3%). In 79 patients (81.4%) sinus rhythm
recovered and persisted until discharge from the hospital. No differences
were found between the groups (group I, 80.7%; group II, 68.5%; group III,
86.7%; group IV, 75%; p = not significant). Three late deaths (3.1%) were
registered. Long-term results show persistence of sinus rhythm in 71% of
group I, 61.2% of group II, 85.8% of group III, and 100% of group IV. The
unique risk factor for late recurrence of atrial fibrillation was found to
be preoperative atrial fibrillation longer than 6 months. Due to the
satisfactory success rate in recovering sinus rhythm, we suggest performing
left atrial isolation in patients with chronic atrial fibrillation
undergoing valvular operations.
ARTICLES
Left atrial isolation associated with mitral valve operations
Cattedra di Cardiochirurgia, Universita degli Studi di Pavia and IRCCS Policlinico S. Matteo, Pavia, Italy.
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