Objective
To explore the operability of concomitant ablation for the patients with valvular heart diseases with left atrium bigger than 60 mm.
Methods
We prospectively included 306 patients with concomitant ablation in our hospital between 2013 and 2015 year. Based on diameter of left atrium measured by intra-operative transesophageal echocardiography (TEE), we separated these patients into two groups including a group L (left atrium >60 mm, 93 patients, 55 males and 38 females at age of 57.0±10.1 years) and a group S (left atrium <60 mm, 213 patients, 120 males and 93 females at age of 55.2±9.9 years) and followed them on 4 time points (time on discharge, three months, six months, and one year after surgery). Then, we analyzed the impact of left atrial size on cardioversion outcome of surgical ablation based on the following data.
Results
The successful rate of the group S and the group L in the 4 time points was 72.8% vs. 75.3%, 74.2% vs. 75.3%, 78.9% vs. 77.4%, and 77.0% vs. 77.4%, respectively . The result of both univariate logistic regression analysis and receiver operation characteristic(ROC) curve analysis showed that there was no statistical difference in cardioversion rates between the group S and the group L. And there was no evident correlation between size of left atrium and ablation failure.
Conclusion
Patients with left atrium enlarged from 60 mm to 70 mm can achieve the same satisfactory results in cardioversion, and should not be the contraindication of concomitant surgical ablation.
ObjectiveTo observe the changes of left atrial geometry before and after mitral valve replacement in patients with different types of mitral valve disease and different heart rhythm, and to identify factors determining left atrial remodeling after mitral valve replacement.
MethodsA total of 215 consecutive patients of mitral valve replacement in Department of Thoracic and Cardiovascular Surgery of West China Hospital, Sichuan University from January 2003 to March 2008 were selected and followed up for this study. There were 52 male and 163 female patients with their age of 40.58±10.54 years (ranged, 18-67 years). St. Jude Medical mechanical valves were used. According to the type of mitral valve diseases (mitral stenosis (MS) or mitral regurgitation (MR)) and heart rhythm (atrial fibrillation (AF) or sinus rhythm (SR)), patients were divided into 4 groups. There were 54 patients with MS and SR (including 13 male and 41 female patients with their age of 39.31±9.46 years), 56 patients with MS and AF (including 14 male and 42 female patients with their age of 41.12±10.72 years), 52 patients with MR and SR (including 12 male and 40 female patients with their age of 39.71±10.09 years), 53 patients with MR and AF (including 13 male and 40 female patients with their age of 40.19±11.87 years). All patients had routine examinations and echocardiogram preoperatively and two years after surgery. Left atrial anteroposterior diameter (LAD), left atrial area (LAA), left atrial volume (LAV) and left atrial volume index (LAVi) were used to analyze the changes of left atrial geometry.
ResultsThere was no in-hospital death. Major postoperative complications included low cardiac output syndrome in 5 patients, pneumonia in 6 patients. LAVi were lower in mitral stenosis patients than that in mitral regurgitation patients (P<0.05), LAVi were lower in patients with sinus rhythm than that in patients with atrial fibrillation (P<0.05). Two years after mitral valve replacement, the extent of left atrial reverse remodeling were significantly greater in mitral regurgitation patients than in mitral stenosis patients (P<0.05), and the extent of left atrial reverse remodeling were significantly greater in patients with sinus rhythm than that in patients with atrial fibrillation (P<0.05).
ConclusionsAge, atrial fibrillation, preoperative left atrial volume, mitral regurgitation, left ventricle end-diastolic diameter are important influencing factors of left atrial reverse remodeling after mitral valve replacement.
ObjectiveTo analyze the clinical characteristics of stiff left atrial syndrome (SLAS) after Mei mini maze procedure for atrial fibrillation (AF), and to explore its risk factors and treatments. Methods We retrospectively analyzed the clinical data of the patients who underwent Mei mini maze procedure in Xinhua Hospital between 2010 and 2020. According to whether SLAS occurred in the early postoperative period, patients were divided into a SLAS group and a non-SLAS group. The basic data, perioperative echocardiogram and laboratory test indexes of the two groups were compared. Results A total of 1 056 patients were collected. There were 672 (63.6%) males with an average age of 63.6±9.3 years, including 489 patients with persistent AF and 567 patients with paroxysmal AF. Fourteen (14/1 056, 1.3%) patients developed SLAS, with an average occurrence time of 2.1±1.1 days after the surgery. The average follow-up time of the whole group was 21.4±7.8 months. Two patients in the SLAS group developed SLAS again after discharge, and the occurrence time was 3 weeks and 4 weeks after the operation, respectively; while no SLAS occurred after discharge in the non-SLAS group. Diabetes and small preoperative left atrial diameter were risk factors for SLAS after surgery. Patients with SLAS had a good prognosis after adequate diuretic therapy. Conclusion The incidence of SLAS after Mei mini maze procedure for AF is low, and it mostly occurs in the early postoperative period. After adequate diuretic treatment, the prognosis is good.
Abstract： Objective To analyze the influence of preoperative left atrial dimension （LAD） on the effectiveness of surgical radiofrequency ablation for the treatment of atrial fibrillation （AF） through a 5-year postoperative follow-up of AF patients after surgical radiofrequency ablation. Methods Clinical data of 433 patients with persistent or permanent AF who received bipolar radiofrequency ablation procedures during concomitant cardiac surgery in Beijing Anzhen Hospital from 2006 to 2009 were retrospectively analyzed. All the patients were divided into 4 groups according to their preoperative LAD：Group A， 75 patients with their LAD＜50 mm， including 22 males and 53 females with their average age of 56.50±10.05 years；Group B， 89 patients with their LAD ranging from 50 to 60 mm， including 32 males and 57 females with their average age of 55.63±10.28 years；Group C， 117 patients with their LAD ranging from 60 to 70 mm， including 41 males and 76 females with their average age of 55.13±10.96 years；and Group D， 152 patients with their LAD＞70 mm， including 68 males and 84 females with their average age of 53.22±11.49 years. Postoperative ECG records right after surgery， before discharge， at 6 months and 1，2，3，4 and 5 years during follow-up were collected. The relationship between preoperative LAD and postoperative sinus rhythm restoration rate was analyzed. Results There was statistical difference in sinus rhythm restoration rate right after surgery（P=0. 011）， before discharge（P=0. 002）， at 6 months（P＜ 0. 001） and 1 year （P＜0. 001）， 2 years（P＜0. 001）， 3 years（P＜0. 001）， 4 years（P＜0. 001） and 5 years（P= 0. 006） during follow-up among the 4 groups. Postoperative sinus rhythm restoration rates right at 6 months and 1，2，3， 4 and 5 years during follow-up was 90.4%， 89.9%， 90.3%， 91.3%， 89.1%， and 90.9% in Group A， 80.2%，79.0%，78.1%， 76.1%，72.5%，70.0% in Group B，74.7%，74.0%，71.2%，72.4%，70.0%， and 64.7% in Group C， and 61.8%，57.6%，56.8%，53.9%，50.7%，and 48.6% in Group D， respectively. Conclusion Patients with a larger preoperative LAD have a lower postoperative sinus rhythm restoration rate after surgical radiofrequency ablation for the treatment of AF.
ObjectiveTo investigate influence of left atrial contraction on lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation.
MethodsClinical data of 57 patients with lone atrial fibrillation underwent minimally invasive radiofrequency ablation in Department of Cardiothoracic Surgery, Xinhua Hospital, Medical School of Shanghai Jiaotong University from September 2010 to December 2011 were retrospectively analyzed. According to the absence of mitral A velocity, patients were divided into Group A (absence of mitral A velocity, 20 patients with their age of 56.32±17.18 years, including 5 females) and Group B (mitral A velocity exists, 37 patients with their age of 60.33±11.22 years, including 17 females). Minimally invasive radiofrequency ablation via thoracoscope were performed in all patients. Preoperative and postoperative left atrial diameter (LAD), left ventricular ejection fraction (LVEF) and mitral A velocity, as well as clinical and follow-up data were recorded and compared.
ResultsPreoperative clinical characters were not statistically different between two groups (P > 0.05). All the patients were followed up for 24.3±8.8 months (range, 12-26 months). Rate of postoperative atrial fibrillation recurrence in group A was significantly higher than that in group B (20.0% vs. 2.7%, P < 0.05). LAD and LVEF of 57 patients at 6 months after surgery were significantly higher than preoperative LAD and LVEF (P < 0.05), but there was no statistic difference between two groups (P > 0.05).
ConclusionDamage of left atrial contraction was related to lone atrial fibrillation recurrence after minimally invasive radiofrequency ablation. Absence of mitral A velocity could be a crucial predictor of postoperative lone atrial fibrillation recurrence.
Objective To examine the effect and safety of thoracoscopic surgery for left atrium myxoma excision.
Method Sixty-nine left atrial myxoma patients underwent excision of left atrial myxoma in our hospital between January 2012 and August 2014 year. The patients were divided into two groups according to the procedure. Thirty patients under-went thoracoscopic surgery, as a thoracoscopic group, with 8 males and 22 females, aged 47.36±13.02 years. Thirty-nine patients received median sternotomy surgery, as a median sternotomy group, with 10 males and 29 females, aged 49.17±13.09 years. The effect and safety between the two groups were compared.
Results All patients survived after surgery without death and other serious complications. Compared with the median sternotomy surgery group, longer cardiopul- monary bypass and aortic cross clamp time, shorter ICU stay, ventilator support, and postoperative drainage time, shorter hospital stay time, less postoperative drainage, lower cost, and more higher rate of returning to work in 1 month after surgery were found in the thoracoscopic group with P value less than 0.05. There was no complication of stroke and other neurological complication in the two groups. All patients were followed up for 11 months to 4 years and 7 months, average age of 38.5±12.7 months. There was no recurrence in both groups.
Conclusions The thoracoscopic left atrial myxoma excision cardiopulmonary is effective and safe. It can be used as a surgical treatment of left atrial myxoma preferred.
ObjectiveTo evaluate the efficacy of the epicardial circumferential left atrial ablation (CLAA) with pulmonary vein isolation (PVI) in curing atrial fibrillation (AF).
MethodsThirty experimental pigs, weight from 60-78 kg, were divided into 3 groups with the method of random sampling:a group of AF (AF group, n=10), a group of PVI (PVI group, n=10), and a group of CLAA and PVI (CLAA+PVI group, n=10). AF mode was induced by rapid atrial pacing. After AF was induced, no ablation was performed for pigs in the AF group, PVI was performed for pigs in the PVI group with bipolar radiofrequency ablation clamp, and the CLAA+PVI group underwent CLAA after accepted PVI with bipolar radiofrequency ablation clamp. After ablation, we applied electrovert on AF pigs to recover to sinus rhythm, then we tested the vulnerability and lasting time of AF in all 3 groups.
ResultsAll pigs developed a stable and sustained AF by rapid left atrial pacing. The pigs of the PVI group and the CLAA+PVI group successfully underwent ablation with the beating heart. Isolated PVI terminated AF in 3 of 20 pigs, and CLAA with PVI terminated AF in 5 of 8 pigs (15% vs. 62.5%, P=0.022). After all pigs recovered to the sinus rhythm, compared with the AF group (10/10), the incidence of sustained AF by burst pacing was statistically decreased in the PVI group (3/10, P=0.003) and the CLAA+PVI group (0/10, P<0.001). There was no statistical difference between the PVI group and the CLAA+PVI group (P=0.211). There was a statistical decreasing of AF duration in the PVI group (P=0.003) and the CLAA+PVI group (P<0.001) compared with the AF group and there was a statistical decreasing of AF duration in the CLAA+PVI group compared to that of the PVI group (P=0.008).
ConclusionCompared with isolated PVI, CLAA+PVI may effectually stop the lasting of AF, restrain the recurrance of AF, and improve the treatment effect of AF.
