Left Atrial Mechanical Function Predicts Postoperative AF in Patients with Rheumatic Mitral Valve Disease Who Underwent Mitral Valve Surgery
2
Citation
26
Reference
10
Related Paper
Citation Trend
Abstract:
Objective: Postoperative atrial fibrillation (PoAF) is a common complication after surgical mitral valve replacement. Late PoAF is independently associated with long-term mortality. This study aimed to test the utility of preoperative left atrial mechanical function as a predictor of early and late PoAF in clinical practice. Methods: Patients (N = 150) with a rheumatic mitral valve who underwent mitral valve replacement with or without tricuspid valvuloplasty and who were in stable sinus rhythm were included. Baseline characteristics and transthoracic echocardiographic assessment information on the day before surgery were collected. Em, Em´, and Ei´ indicate early diastolic peak velocity of the mitral valve, early diastolic velocity at the lateral wall of the mitral annulus, and early diastolic velocity at the interventricular septal annulus, respectively. Results: Early PoAF was present in 59 of 150 patients (39.3%), and 32 of 150 patients (21.3%) developed late PoAF within 1 year after surgery. Among all of the variables examined, age, diabetes, early mitral filling velocity (Mitral E), left atrial mechanical function (Mitral A), Em/Em´, Em/Ei´, and mitral transvalvular gradient showed a significant correlation with PoAF. Only age, Mitral A, and mitral transvalvular gradient showed strong, significant correlations with the occurrence of late PoAF. In a multivariate analysis, predictors of late PoAF recurrence included early PoAF and Mitral A. Conclusion: Routine evaluation of Mitral A is feasible and useful to predict early and late PoAF in patients with a rheumatic mitral valve undergoing surgical mitral valve replacement.Keywords:
Mitral valve replacement
The mitral valve edge-to-edge repair (ETER) procedure inevitably alters mitral valve leaflet mechanics. The study aim was to quantify the effects of papillary muscle (PM) position on stretches in the central area of the anterior leaflet after mitral valve ETER.Sixteen markers of a 4x4 array were attached onto the central area of the mitral valve anterior leaflet. The free edges of the mitral valve leaflets were sutured together with a single stitch to mimic the ETER. The mitral valve was then mounted in an in-vitro flow loop that was capable of simulating physiological loading conditions. The PM of the mitral valve was set in slack, normal, and taut positions. Displacements of the markers were obtained from the images of the markers, in order to calculate the stretches and stretch rates.The major principal stretch during systole was significantly greater than that during diastole in the three PM positions. The major principal (radial) stretch was significantly greater in the taut PM position than in the normal and slack PM positions during diastole. However, there was no significant difference in the minor principal (circumferential) stretch during diastole in the three PM positions. The loading and unloading stretch rates were not affected by the PM position, except for the major principal stretch rate during loading.With regards to the central region of the mitral valve anterior leaflet, the radial stretch during diastole was significantly less than that during systole. Therefore, the load on the anterior leaflet during systole, rather than that during diastole, should be considered when evaluating ETER durability, especially in the taut PM position. The circumferential stretch during diastole was not influenced by the PM positions.
Papillary muscle
Leaflet (botany)
Systole
Cite
Citations (9)
Atrial fibrillation is the most frequent sustained arrhythmia. It is associated with higher morbidity and mortality of patients. Cryoablation was introduced to the current practise in cardiac surgery as a non-pharmacological method of therapy of atrial fibrillation. The aim of the study was to assess the effect of surgical ablation of atrial fibrillation on the attainment and maintenance of sinus rhythm in patients undergoing concomitant cardiac surgery.Ninety four consecutive patients with atrial fibrillation (paroxysmal, persistent or permanent) were followed up prospectivelly. The mean age was 67.8 years; there were 39 (41.5%) women in the study group. Forty two patients (44.7%) had paroxysmal or persistent atrial fibrillation and 52 (55.3%) of them had permanent atrial fibrillation before surgery. Patients with permanent atrial fibrillation had significantly bigger preoperative left atrial diameter (51.2 versus 46.6 mm) and more severe tricuspid regurgitation (grade 2.3/4 versus grade 1.4/4) compared to the group with paroxysmal and persistent atrial fibrillation. Mitral valve surgery was significantly more frequent in patients with permanent atrial fibrillation too. Operations were performed between January 2005 and July 2006 using flexible argon-based cryoablative device. Sinus rhythm was achieved statistically significantly more frequently in patients with preoperative paroxysmal and persistent atrial fibrillation in comparison with patients with permanent atrial fibrillation--at discharge, 1, 3.5 and 6 months after operation (90.5-96.3 % versus 50-65.9%). At 12 months it was only statistical trend (84.6% versus 63.3%). Kaplan-Meier analysis demonstrated a 79.4% freedom from atrial fibrillation at 12 months. Preoperative atrial size and duration of atrial fibrillation were the most significant negative predictors of maintenance of sinus rhythm. Four patients (9.3%) required postoperative permanent pacemaker placement. Ischemic stroke occured in 5 (5.3%) patients. Thirty-day motality was 12.9% (12 patients).Perioperative ablation of atrial fibrillation using cryoenergy is effective therapeutic method for restoring and maintenance of sinus rhythm in relatively high proportion of patients. The most significant predictors of late recurrence are preoperative atrial size and duration of atrial fibrillation. This non-pharmacological method should be routinely used in patients undergoing concomitant cardiac surgery.
Concomitant
Cryoablation
Cite
Citations (1)
Cite
Citations (46)
Objective To investigate the hypercoagulation state markers in patients with atrial fibrillation and their clinical significance.Methods Sixty patients with chronic atrial fibrillation were divided into two groups,one group having no heart failure(group one,n=30) and the other having heart failure(group two,n=30).There were two age-matched and sex-matched control groups,the normal sinus rhythm group including 40 patients with cardiovascular disease but in sinus rhythm and normal heart function, the health control group including 33 healthy subjects.The plasma fibrin D-dimer was assayed using enzyme linked immunoassay.Fibrinogen(Fg) was measured.Results Compared with the healthy control group and the normal sinus rhythm group,patients with atrial fibrillation(group one) had significant increase of fibrin D-dimer(474.5) μg/L((220.0)-(843.9) μg/L) and Fg((3.74)±(0.76)) g/L,patients with atrial fibrillation and heart failure(group two) had significant increase of fibrin Ddimer(657.9) μg/L((365.8)-(1448.6) μg/L) and Fg((4.25)±(0.95)) g/L,(P(0.05)).Plasma Fg and D-dimer level were higher in group two than that in group one,(P(0.05)).In atrial fibrillation patients with left atrial diameter≥40 mm,Plasma Fg and(D-dimer) level were higher than those with left atrial diameter40 mm(P(0.05)).Conclusion Patients with atrial fibrillation show evidence of hypercoagulation,which may be correlated with the atrial thrombogenesis.In patients with atrial fibrillation,heart failure and left atrial diameter effect the levels of plasma Ddimer and Fg.
D-dimer
Cite
Citations (0)
Mitral valve edge-to-edge repair (ETER) alters valve mechanics, which may impact efficacy and durability of the repair. The objective of this paper was to quantify stretches in the central region of the anterior leaflet of the mitral valve after ETER with a single suture and 6 mm suture. Sixteen markers, forming a 4x4 array, were attached onto the central region of the mitral valve anterior leaflet. The mitral valve was subjected to ETER with a single suture and 6 mm suture, and mounted in an in vitro flow loop simulating physiological conditions. Images of the marker array were used to calculate marker displacement and stretch. A total of 9 mitral valves were tested. Two peak stretches were observed during a cardiac cycle, one in systole and the other in diastole under mitral valve edge-to-edge repair condition. The major principal (radial) stretch during systole was significantly greater than that during diastole. However, there was no significant difference between the minor principal (circumferential) stretch during diastole and that during systole. In addition, there were no significant differences in the radial and circumferential, or areal stretches and stretch rates during diastole between the single suture and 6 mm suture. The ETER subjects the mitral valve leaflets to double frequency of loading and unloading. Minor change in suture length may not result in a significant load difference in the central region of the anterior leaflet during diastole.
Systole
Cardiac cycle
Leaflet (botany)
Cite
Citations (11)
Surgical interventions because of mitral valve disease have been ascribed since 1951. Many changes within mitral valve replacement have passed including closed and open mitral commissurotomy, mitral valve repair operations implantation of mechanical, biological heart valve and finally use of mitral valve homograft. Despite changes in chirurgical tactics and medico-technical environment, mitral valve homograft implantation remains one of the most complex surgical interventions. Surgical and technical details of mitral valve homograft implantation are discussed.to estimate technical difficulties and anatomical positioning of mitral valve homograft considering a spectrum of indications of mitral valve replacement.62-year-old woman 26 years ago underwent mitral valve replacement with Starr-Edwards mitral valve prosthesis, because of rheumatic heart disease by homograft. Due to malfunction of the mitral valve prosthesis, and progressive left ventricular failure patient was reoperated on 26(th) of February 2002. Fresh antibiotic preserved mitral valve homograft was implanted. Surgical techniques were guided using left ventricle size measurement indicated by echocardiography.The technique described by Acar/Carpentier was used except of mitral valve annuloplasty ring implantation. Peri- and early postoperative period was free of homograft related complications. The left ventricle function was improving and the heart size decreased dramatically during first postoperative week.The most important peculiarities for mitral valve homograft implantation are echocardiography data and intraoperative left ventricle measurements. Homograft implantation techniques are rather demanding therefore indications for mitral valve replacement have to be selected carefully and should be based on the presence of severe mitral valve dysfunction in order to achieve best hemodynamic results and prevent patient from anticoagulation therapy.
Mitral valve replacement
Cite
Citations (0)
Abstract We report the first successful implantation in the United States of a novel mitral valve (MITRIS RESILIA by Edwards Lifesciences) in a patient with history of mitral valve replacement at a young age. This new bioprosthetic valve offers a unique profile and innovative option for mitral valve replacement in patients who are at risk of left ventricular outflow tract obstruction.
Mitral valve replacement
Ventricular outflow tract
Cite
Citations (2)
Mitral valve replacement
Valve replacement
Cite
Citations (1)
The aim of this prospective study was to assess the presence of sinus rhythm and atrial transport function after surgical ablation of atrial fibrillation using cryoenergy, and to evaluate predictors of the success of the procedure.Between January 2005 and September 2006, 100 consecutive patients underwent left atrial cryoablation as a concomitant surgical procedure (46 patients with paroxysmal or persistent atrial fibrillation and 54 with permanent atrial fibrillation). Mitral valve surgery was performed in 74%. The mean and the median times of follow-up were 20 +/- 8.5, and 24 months respectively. Atrial mechanical function was assessed by echocardiography.Sinus rhythm was achieved during the postoperative follow-up in 71-81% of patients - significantly more often in the group with paroxysmal and persistent atrial fibrillation (90-98%), than patients with permanent atrial fibrillation prior to surgery (51-65%) (p<0.002). At 12 and 24 months after the surgery, a total of 68.2% and 51.2% of the patients were free from atrial fibrillation; 73.9% and 60.7% of the patients from the paroxysmal and persistent atrial fibrillation group, and 60.3% and 37.7% of patients with permanent atrial fibrillation (p=0.05). Five per cent of patients required postoperative permanent pacemaker implantation. An effective left and right atrial mechanical function was detected in 70-90%, and 96-98% of patients with sinus rhythm respectively. The following circumstances were identified as negative predictors of the presence of sinus rhythm after the ablation procedure: growing diameter of the left atrium, the duration of atrial fibrillation and the severity of mitral and tricuspid regurgitation before surgery (p<0.05). Restoration of the left atrial transport function was negatively predicted by the preoperative diameter of the left atrium, the presence of mitral valve stenosis and the severity of tricuspid regurgitation (p<0.05). A total of 95.4% of patients were free from stroke at one-year follow-up, and 94.1% at 2 years after surgery.Stable sinus rhythm and effective left atrial transport function are the main factors resulting in decreased morbidity after successful ablation of atrial fibrillation. A careful post-operative follow-up of the patients and individualised treatment are necessary.
Cite
Citations (9)
Mitral valve replacement
Concomitant
Valve replacement
Cite
Citations (53)