Continuous monitoring of cardiac rhythm may play an important role in measuring the true symptomatic/asymptomatic atrial fibrillation (AF) burden and improve the management of anti-arrhythmic and anti-thrombotic therapies. Forty-seven patients with mitral valve disease and longstanding persistent AF (LSPAF) underwent a left atrial maze procedure with bipolar radiofrequency and valve surgery. The follow-up data recorded by an implanted loop recorder were analysed after 3, 6 and 12 months. On discharge, 40 (85.1%) patients were in stable sinus rhythm, as documented by in-office electrocardiography (ECG), 4 (8.5%) were in pacemaker rhythm and 3 (6.4%) were in AF. One (2.1%) patient died after 7 months. On 12-month follow-up examination, 30 (65.2%) patients had an AF burden 0.5%. Two (4.3%) patients with AF recurrences were completely asymptomatic. Among the symptomatic events stored by the patients, only 27.6% was confirmed as genuine AF recurrences according to the concomitant ECG recorded by the implanted loop recorder. A concomitant bipolar maze procedure during mitral valve surgery is effective in treating AF, as proved by detailed 1-year continuous monitoring.
This study was undertaken in order to evaluate the usefulness of the Euroscore in the choice and outcome of mitral valve procedures undertaken at the Helsinki University Central Hospital.
Data from 378 patients was collected. predicted mortalities were calculated for all patients using the European System for Cardiac Operative Risk Evaluation and different mitral valve procedures were compared with 30-day mortality, length of hospital care and rate of post-operative complications.
The mortality rate in the mitral valve repair (MVP) group decreased gradually from 5.9% (in 1999) to 2.2% (2003). The variation of annual mortality was higher in the mitral valve replacement (MVR) group. The predicted mortality given by Euroscore increased over the years in both groups. The mortality in the MVR group was nearly four times higher than in the MVP group. the length of both intensive and overall hospital stay decreased in patients with MVP procedures. Post-operative survival was 89% in the MVP patients and 74% in mvr patients after three years.
The results of mitral valve operations have improved. This is observed as decreased mortality rates and lengths of hospital care in the MVP group, although the predicted mortality rate was increased.
The efficacy of concomitant ablation techniques in patients with paroxysmal atrial fibrillation (AF) undergoing mitral valve surgery remains under debate. The aim of this prospective, randomized, single-centre study was to compare pulmonary vein isolation (PVI) only versus a left atrial maze (LAM) procedure in patients with paroxysmal AF during mitral valve surgery.
Between February 2009 and June 2011, 52 patients with a mean age of 54.2 (standard deviation 7.2 years) underwent mitral valve surgery and concomitant bipolar radiofrequency ablation for paroxysmal AF. Patients were randomized into the PVI group (n = 27) and the LAM group (n = 25). After surgery, an implantable loop recorder for continuous electrocardiography (ECG) monitoring was implanted. Patients with an AF burden (AF%) of
Surgery for atrial fibrillation (AF) has been demonstrated as an effective treatment to restore and maintain sinus rhythm in patients for whom a rhythm control strategy is desired. It is usually offered to patients undergoing other types of cardiac surgery (eg, mitral valve repair or replacement, coronary artery bypass grafting, aortic valve surgery, intracardiac defects, ascending aortic surgery). It is also feasible as a stand-alone procedure, bearing a high success rate. In the past few years, less-invasive procedures have been described. AF is a triggered arrhythmia, resulting from ectopic activity most commonly located in and around the pulmonary veins of the left atrium. Therefore, electrical isolation of the pulmonary veins from the rest of the left atrium in order to prevent AF from being triggered is the rationale common to all surgical techniques. Further substrate modification may be required in patients with more persistent AF. This is done by adding ablation of the posterior left atrium with connecting lines of block between pulmonary veins, to the mitral valve annulus, as well as in specific sites in the right atrium. The left atrial appendage is resected or occluded at the same time. Despite patients' high rate of freedom from AF after surgery (70%-85% at 1 year), surgical ablation of AF has never been clearly shown to alter long-term mortality. The available literature supports the recommendation to stop oral anticoagulation therapy 6 months after surgery when sinus rhythm can be documented, because a very low rate of thromboembolic events is reported. However, there is no evidence-based data to support the safety of omitting long-term oral anticoagulation. Thus, surgery should be used primarily as a concomitant procedure during cardiac surgery for other diseased states or as a stand-alone procedure after failure of prior attempts of catheter ablation and antiarrhythmic drugs.
Repair of mitral regurgitation (MR) due to bileaflet prolapse poses many technical challenges. The late outcomes after repair are also not well characterized in this population. Published series have often included patients with mixed causes of prolapse and/or lack long-term echocardiographic follow-up. Myxomatous disease represents an important cause of bileaflet prolapse and MR and, thus, served as the focus of the present study.
A total of 142 patients, mean age 60.4 ± 13.2 years, underwent mitral valve (MV) repair of bileaflet prolapse due to myxomatous disease from 2001 to 2010. Concomitant coronary artery bypass grafting was performed in 16 patients (11%). All patients were followed up by a dedicated MV clinic with a follow-up interval that extended up to 8.6 years.
No hospital deaths occurred. Ring annuloplasty was used for all patients. Additional MV repair techniques included chordal transfer in 73, a hybrid-flip-over technique in 23, polytetrafluoroethylene neochords in 26, edge-to-edge repair in 11, and commissuroplasty in 9. Prolapse involving more than 1 posterior leaflet scallop was observed in 103 patients (73%), and prolapse of more than 1 anterior leaflet scallop was observed in 76 (54%). During follow-up, 4 patients had MR grade 2+ or greater, and 2 patients required subsequent MV reoperation. The 5-year survival, freedom from recurrent MR (= 2+), and freedom from MV reoperation was 95.2% ± 2.8%, 92.6% ± 3.9%, and 94.0% ± 4.9%, respectively.
MV repair of bileaflet prolapse due to myxomatous disease is safe and durable. Successful repair often requires a combination of surgical repair techniques.
In 23 of 154 patients with congenital mitral valve (MV) insufficiency the MV prosthetics was conducted, and in 23-valve-preserving reconstructive operation. Operative procedures were depicted, early and late follow-up results were analyzed. After the valve-preserving operation conduction hospital lethality was 8.7%, and after the (MV) prosthetics-34.8%. In the late follow-up period after (MV) plastic reconstruction conduction good results were noted in 17 patients, satisfactory-in 1, reoperation was performed in 3 (13%). Application of soft synthetic ring, preventing the dilation of the valve fibrotic ring, may to lower the frequency of reoperation conduction. Plastic correction of the CMVI permits to eliminate the basic haemodynamical disorders and to avoid or postpone the MV prosthetics conduction, what especially important in children.
To determine the indicators of risk for hospital death, patients undergoing reoperative valve replacement were analyzed
Four hundred and eighteen consecutive patients undergoing reoperative valve replacement from 1977 to 1994 were reviewed using univariate and multivariate analysis.
Overall hospital mortality was 11.2% with 9.4% mortality with aortic valve replacement and 14.2% with mitral valve replacement (P=0.52). Mortality was 9.7% for patients less than 70 years of age compared with 19.4% for older patients (P=0.03), and was 8.5% for those with anoxia times less than 90 mins versus 21.9% for those with longer anoxia times (P=0.001). For first reoperations, 9.5% of patients died, while for patients undergoing second or more reoperation, mortality was 23.2% (P=0.01). While mortality increased from 8.9% to 19.0% with the addition of a concomitant procedure (P=0.008), it was not affected if the additional procedure was a coronary bypass (P=0. 96). The indication for surgery influenced outcome. Mortality was zero for thromboembolism, 9% for structural failure, 23% for nonstructural failure and 22% for endocarditis (P=0.006). For New York Heart Association (NYHA) functional class I patients, mortality was 1.6% compared with 22.3% for those in NYHA class IV (P=0.006). By multivariate analysis, however, only the indication for surgery and the NYHA functional class influenced survival.
Reoperative valve surgery can be performed with a survival (88.8%) that is similar to the initial procedure (91.2%). The indication for surgery and NYHA functional class alone influenced outcome; therefore, possible early reoperation is indicated before clinical deterioration occurs.