Cardiac autotransplantation for the treatment of permanent atrial fibrillation combined with mitral valve disease.
OBJECTIVE
The results of current surgical options for the treatment of permanent atrial fibrillation associated with mitral valve surgery are widely different, particularly for extremely dilated left atria. The aim of this study is to assess the efficacy of cardiac autotransplantation in restoring a normal sinus rhythm via a consistent reduction in the left atrium volume associated with a complete isolation of the pulmonary veins.


METHODS
From April 2000 to April 2002, 28 patients (men/women, 5/23) underwent cardiac autotransplantation for the treatment of mitral disease and concomitant permanent atrial fibrillation (>1 year). A modified surgical technique derived from bicaval heart transplantation procedures maintained the connection of the right atrium with the inferior vena cava in all but 3 cases. In 2 patients, the mitral valve was repaired, and it was replaced in 26 patients. Associated procedures were 6 aortic valve replacements, 2 tricuspid valve annuloplasties, and 2 coronary revascularizations.


RESULTS
No hospital deaths were recorded, but 1 patient died of pneumonia 3 months postoperatively. At a mean follow-up period of 17.2 +/- 6.7 months (range, 6-30 months), 24 patients (88.9%) were in sinus rhythm, and 3 (11.1%) were in atrial fibrillation. The Santa Cruz Score was 0 for 3 patients, 2 for 1 patient, and 4 for the remaining 23 patients (85.2%). The mean left atrial diameter decreased from 65.4 +/- 17.1 mm (range, 50-130 mm) before the operation to 48.4 +/- 5.6 mm (range, 37-78 mm) postoperatively (P <.001), and the mean left atrial volume decreased from 119 +/- 70.5 mL (range, 60-426 mL) to 69.1 +/- 35.1 mL (range, 31-226 mL) (P <.0001).


CONCLUSIONS
Cardiac autotransplantation is a safe and effective surgical option for the treatment of permanent atrial fibrillation in patients with long-lasting mitral valve disease and severe enlargement of the left atrium.
Troise
Giovanni
G
Cardiac Surgery Unit, Poliambulanza Hospital, Brescia, Italy.
Brunelli
Federico
F
Cirillo
Marco
M
Amaducci
Andrea
A
Mhagna
Zen
Z
Tomba
Margherita Dalla
MD
Tasca
Giordano
G
Quaini
Eugenio
E
D000368:Aged; D001281:Atrial Fibrillation / Q000601:surgery*; D006332:Cardiomegaly / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000601:surgery; D016027:Heart Transplantation / Q000379:methods*; D006349:Heart Valve Diseases / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000601:surgery*; D011667:Pulmonary Veins / Q000601:surgery; D014182:Transplantation, Autologous