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Open AccessArticle

Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications

1
Division of Cardiology, “Città della Salute e della Scienza di Torino” Hospital, Department of Medical Sciences, University of Turin, 10124 Torino, Italy
2
Cardiology Unit, “Ospedale Civico”, Chivasso, 10034 Torino, Italy
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Division of Cardiac Surgery, “Città della Salute e della Scienza di Torino” Hospital, University of Turin, 10124 Torino, Italy
4
Cardiology Department, Clinica Pinna Pintor, 10129 Torino, Italy
*
Author to whom correspondence should be addressed.
Medicina 2019, 55(10), 709; https://doi.org/10.3390/medicina55100709
Received: 31 July 2019 / Revised: 16 September 2019 / Accepted: 16 October 2019 / Published: 21 October 2019
(This article belongs to the Special Issue Stroke, Dementia and Atrial Fibrillation)
Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 ± 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 ± 13.1 mL/mq and 25.1 ± 7.3%) were significantly better than in those with AF relapses (76.8 ± 16.2 mL/mq and 17.5 ± 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 ± 17.8 mL/mq, with total LA emptying fraction derived from volumes 23.6 ± 13.7%; patients with strokes in SR showed very enlarged LA volume (>70 mL/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR. View Full-Text
Keywords: atrial fibrillation; surgical cryoablation; left atrial function; minimally invasive mitral valve repair; echocardiography; ischemic cerebral events atrial fibrillation; surgical cryoablation; left atrial function; minimally invasive mitral valve repair; echocardiography; ischemic cerebral events
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Anselmino, M.; Rovera, C.; Marchetto, G.; Castagno, D.; Morello, M.; Frea, S.; Gaita, F.; Rinaldi, M.; De Ferrari, G.M. Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications. Medicina 2019, 55, 709.

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