Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
Heart Valves Surgery Department, E. Meshalkin National Medical Research Center, Novosibirsk, Russian Federation.
Heart Lung Circ. 2021 Jun;30(6):922-931. doi: 10.1016/j.hlc.2020.10.027. Epub 2020 Dec 11.
The influence of left atrium (LA) enlargement on atrial arrhythmia recurrence (AAR) after surgical ablation in patients with mitral valve (MV) disease remains unresolved.
Left atrial size is critical to the success of concomitant atrial fibrillation (AF) ablation in patients scheduled for MV surgery. However, a large LA should not be a limiting factor when evaluating surgical candidates with AF if they receive appropriate treatment during concomitant ablation. This randomised study assessed whether adding LA reduction (LAR) to the maze procedure for MV surgery patients can improve freedom from AAR.
From September 2014 to September 2017, 140 patients were randomly assigned into two groups. The maze group underwent MV surgery with concomitant surgical AF ablation (n=70). The maze + LA reduction group underwent MV surgery with concomitant AF ablation and LA reduction procedure (n=70). Rhythm outcomes were estimated by Holter monitoring, according to Heart Rhythm Society guidelines.
The concomitant LA reduction procedure did not increase early mortality and complications rates. Significant differences in freedom from AAR were observed at 24 months (maze, 78.4%; maze + LAR group, 92.3%; p=0.025). A significant difference in LA volume was detected at discharge (p<0.0001); however, it was not significantly different at 24 months (p=0.182).
Adding LA reduction to the maze procedure led to improvements in freedom from AAR for patients with AF and LA enlargement scheduled for MV surgery. A concomitant LA reduction procedure did not increase mortality and perioperative risk.
左心房（LA）扩大对二尖瓣（MV）疾病患者手术消融后房性心律失常复发（AAR）的影响仍未解决。
左心房大小对同期房颤（AF）消融患者 MV 手术的成功至关重要。然而，如果 AF 患者在同期消融过程中接受了适当的治疗，那么 LA 较大不应成为评估手术候选者的限制因素。这项随机研究评估了在 MV 手术患者的迷宫手术中增加左房缩小（LAR）是否可以提高无 AAR 率。
从 2014 年 9 月至 2017 年 9 月，140 名患者被随机分为两组。迷宫组接受 MV 手术伴同期手术 AF 消融（n=70）。迷宫+LA 缩小组接受 MV 手术伴同期 AF 消融和 LA 缩小手术（n=70）。根据心律学会指南，通过动态心电图监测评估节律结果。
同期 LA 缩小术并未增加早期死亡率和并发症发生率。24 个月时无 AAR 率的差异有统计学意义（迷宫组 78.4%，迷宫+LAR 组 92.3%，p=0.025）。出院时 LA 容积差异有统计学意义（p<0.0001）；然而，24 个月时差异无统计学意义（p=0.182）。
在迷宫手术中加入 LA 缩小术可提高 AF 合并 LA 扩大患者接受 MV 手术的无 AAR 率。同期 LA 缩小术不会增加死亡率和围手术期风险。
