Atrial remodeling after mitral valve surgery in patients with permanent atrial fibrillation.
BACKGROUND
Mitral valve pathology is frequently associated with auricular dilatation and atrial fibrillation. Mitral surgery allows an immediate surgical auricular remodeling and besides in those cases in which sinus rhythm is reached, it is followed by a late remodeling. The aim of this study is to investigate the process of postoperative auricular remodeling in patients with permanent atrial fibrillation undergoing mitral surgery.


METHODS
In a prospective randomized trial, 50 patients with permanent atrial fibrillation and dilated left atrium, submitted to surgical mitral repair, were divided into two groups: Group I contained 25 patients with left auricular reduction and mitral surgery, and Group II contained 25 patients with isolated valve surgery. Both groups were considered homogeneous in the preoperative assessment.


RESULTS
After a mean follow-up of 31 months, 46% of patients included in Group I versus 18% of patients included in Group II restarted sinus rhythm (p = 0.06). An auricular remodeling with size regression occurred in those patients who recovered from sinus rhythm, worthy of remark in Group II (-10.8% of left auricular volume reduction in Group I compared to -21.5% in Group II; p < 0.05). A new atrial enlargement took place in those patients who remained with atrial fibrillation (+16.8% left auricular volume in Group I vs. +8.4% in Group II; p < 0.05).


CONCLUSIONS
Mitral surgery produces an atrial postoperative volume that decrease especially when reduction techniques are employed. Late left atrial remodeling depended on the type of atrial rhythm and postoperative surgical volume.
Hornero
Fernando
F
Department of Cardiac Surgery, University General Hospital of Valencia, Spain. hornero_fer@gva.es
Rodriguez
Ignacio
I
Buendía
Jose
J
Bueno
Maria
M
Dalmau
Maria J
MJ
Canovas
Sergio
S
Gil
Oscar
O
Garcia
Rafael
R
Montero
Jose A
JA
D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications / Q000503:physiopathology*; D006348:Cardiac Surgical Procedures / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000503:physiopathology*; D006349:Heart Valve Diseases / Q000150:complications / Q000503:physiopathology / Q000601:surgery*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000503:physiopathology / Q000601:surgery*; D011446:Prospective Studies