Zhou Can, Zhao Yichen, Zhao Cheng, Ye Qing, Dong Jianzeng, Wang Jiangang
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100000 Beijing, China.
Department of Cardiac Surgery, Beijing Anzhen Hospital, Capital Medical University, 100000 Beijing, China.
Rev Cardiovasc Med. 2024 Jan 9;25(1):13. doi: 10.31083/j.rcm2501013. eCollection 2024 Jan.
Left atrial appendages (LAAs) play an important role in regulating left atrial function, and much evidence supports the possibility that changes in left atrial structure may cause or worsen mitral regurgitation. This study intended to investigate the outcomes of patients with mitral regurgitation who underwent left atrial appendage closure (resection or endocardial closure) during isolated surgical ablations.
Patients with mild or moderate mitral regurgitation who received isolated surgical ablations for atrial fibrillation (AF) in our center from 2013 to 2022 were referred. During follow-up, each clinical visit was composed of medical interrogation, a 24 h Holter, and echocardiographic evaluation. Death, atrial fibrillation, worsening of mitral regurgitation, and stroke were evaluated as outcomes. Freedom from outcomes whose results were adjusted by inverse probability of treatment weighting for causal effects after acquiring propensity scores.
A total of 456 patients were enrolled in this study. During a median follow-up of 48 months, 30 deaths and 11 cases of stroke were observed. After adjustments, no significant differences in terms of death or stroke were observed among the three groups. Patients who underwent resection or endocardial closure during surgical ablations had a higher risk of mitral regurgitation worsening during follow-up ( 0.05). During the whole follow-up, patients who underwent left atrial appendage interventions showed significantly larger left atrial and mitral annular diameters, as well as lower tethering height than those who had left atrial appendage preserved (all 0.05).
Mitral regurgitation was more likely to get worse when patients with fundamental mitral diseases underwent LAA interventions during isolated surgical AF ablations. In the absence of LAA, the dilation of the left atrium and mitral annulus may ultimately lead to worsening of regurgitation.
左心耳在调节左心房功能中起重要作用，且有大量证据支持左心房结构改变可能导致或加重二尖瓣反流的可能性。本研究旨在调查在孤立性手术消融期间接受左心耳闭合（切除或心内膜闭合）的二尖瓣反流患者的结局。
纳入2013年至2022年在本中心因心房颤动（AF）接受孤立性手术消融的轻、中度二尖瓣反流患者。随访期间，每次临床就诊包括医学问诊、24小时动态心电图监测和超声心动图评估。将死亡、心房颤动、二尖瓣反流恶化和卒中作为结局进行评估。在获得倾向得分后，通过治疗加权逆概率对因果效应调整后的结局进行无事件生存分析。
本研究共纳入456例患者。在中位随访48个月期间，观察到30例死亡和11例卒中。调整后，三组在死亡或卒中方面未观察到显著差异。在手术消融期间接受切除或心内膜闭合的患者在随访期间二尖瓣反流恶化的风险更高（P<0.05）。在整个随访期间，接受左心耳干预的患者与保留左心耳的患者相比，左心房和二尖瓣环直径显著更大，且瓣叶牵拉高度更低（均P<0.05）。
在孤立性手术房颤消融期间，患有基础二尖瓣疾病的患者接受左心耳干预时，二尖瓣反流更有可能恶化。在没有左心耳的情况下，左心房和二尖瓣环的扩张最终可能导致反流恶化。
