title: Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery?
abstract: BACKGROUND
  Severe primary mitral regurgitation (MR) carries a significant incidence of mortality and morbidity. Though a number of prognostic factors have been identified, the best timing for mitral valve repair is still debated. We assessed the role of Left Atrial Volume Indexed (LAVI) as predictor of adverse events after mitral valve surgery.
  
  
  METHODS
  134 patients with severe MR were studied with a follow-up of 42±16months. Endpoints were Post-Operative Atrial Fibrillation (POAF), atrial and ventricular remodeling (LARR/LVRR) and correlation with outcome. POAF was defined as AF occurring within 2weeks and late AF (LAF) more than 2weeks after surgery. LARR was defined as LAVI reduction ≥15% and LVRR as any reduction of ventricular mass after surgery.
  
  
  RESULTS
  Forty-one patients experienced POAF, 26 had LAF. Pre-operative LAVI was an independent risk factor for POAF (OR 1.03, CI [1.00-1.06], p=0.01), LAF (OR 1.03, CI [1.00-1.06], p=0.02), LARR and LVRR (OR 1.04, CI [1.01-1.07], p=0.002, respectively). LARR was found in 75 patients, while LVRR in 111. Patients with heart remodeling had less incidence of LAF and cardiac adverse events, better diastolic function and improved their NYHA class after surgery.
  
  
  CONCLUSIONS
  LAVI should be given more weight into decision making for patients with MR as it predicts POAF and LAF and reverse atrial and ventricular remodeling, both associated to long-term outcome.
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy. Electronic address: dottgiuseppedigioia@gmail.com.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Di Gioia
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Simona
authors.initials: S
authors.lastname: Mega
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiac Surgery, Campus Bio-Medico University of Rome, Italy.
authors.forename: Antonio
authors.initials: A
authors.lastname: Nenna
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Cosimo Marco
authors.initials: CM
authors.lastname: Campanale
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Iginio
authors.initials: I
authors.lastname: Colaiori
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Domenico
authors.initials: D
authors.lastname: Scordino
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Ragni
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Miglionico
authors.affiliation: Department of Medicine and Surgery, Unit of Cardiology, Campus Bio-Medico University of Rome, Italy.
authors.forename: Germano
authors.initials: G
authors.lastname: Di Sciascio
mesh_terms: D000368:Aged; D004452:Echocardiography / Q000639:trends; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D019918:Heart Valve Prosthesis Implantation / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging* / Q000601:surgery*; D009929:Organ Size; D011300:Preoperative Care / Q000639:trends*
keywords: Atrial fibrillation; Left atrial volume; Mitral valve prolapse; Mitral valve surgery; Remodeling