Should pre-operative left atrial volume receive more consideration in patients with degenerative mitral valve disease undergoing mitral valve surgery?
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- 作者：Giuseppe Di Gioiaa ; dottgiuseppedigioia@gmail.com ; Simona Megaa ; Antonio Nennab ; Cosimo Marco Campanalea ; Iginio Colaioria ; Domenico Scordinoa ; Laura Ragnia ; Marco Miglionicoa ; Germano Di Sciascioa
- 关键词：Left atrial volume ; Mitral valve surgery ; Mitral valve prolapse ; Remodeling ; Atrial fibrillation
- 刊名：International Journal of Cardiology
- 出版年：2017
- 出版时间：15 January 2017
- 年：2017
- 卷：227
- 期：Complete
- 页码：106-113
- 全文大小：651 K
- 卷排序：227
文摘
Severe primary mitral regurgitation (MR) carries a significant incidence of mortality and morbidity. Though a number of prognostic factors have been identified, the best timing for mitral valve repair is still debated. We assessed the role of Left Atrial Volume Indexed (LAVI) as predictor of adverse events after mitral valve surgery.Methods134 patients with severe MR were studied with a follow-up of 42 ± 16 months. Endpoints were Post-Operative Atrial Fibrillation (POAF), atrial and ventricular remodeling (LARR/LVRR) and correlation with outcome. POAF was defined as AF occurring within 2 weeks and late AF (LAF) more than 2 weeks after surgery. LARR was defined as LAVI reduction ≥ 15% and LVRR as any reduction of ventricular mass after surgery.ResultsForty-one patients experienced POAF, 26 had LAF. Pre-operative LAVI was an independent risk factor for POAF (OR 1.03, CI [1.00–1.06], p = 0.01), LAF (OR 1.03, CI [1.00–1.06], p = 0.02), LARR and LVRR (OR 1.04, CI [1.01–1.07], p = 0.002, respectively). LARR was found in 75 patients, while LVRR in 111. Patients with heart remodeling had less incidence of LAF and cardiac adverse events, better diastolic function and improved their NYHA class after surgery.ConclusionsLAVI should be given more weight into decision making for patients with MR as it predicts POAF and LAF and reverse atrial and ventricular remodeling, both associated to long-term outcome.