PMID- 34394984
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220425
IS  - 2090-8016 (Print)
IS  - 2090-0597 (Electronic)
IS  - 2090-0597 (Linking)
VI  - 2021
DP  - 2021
TI  - Left Atrial Appendage Exclusion in Atrial Fibrillation Radiofrequency Ablation 
      during Mitral Valve Surgery: A Single-Center Experience.
PG  - 9999412
LID - 10.1155/2021/9999412 [doi]
LID - 9999412
AB  - BACKGROUND: Atrial fibrillation surgical radiofrequency ablation (AFSA) during 
      mitral valve surgery (MVS) has almost completely superseded the Cox-Maze 
      procedure for the treatment of atrial fibrillation. METHODS: We retrospectively 
      analyzed 100 patients who underwent MVS + AFSA in our institution from January 
      2008 to June 2017. We compared the effectiveness of AFSA in patients who 
      underwent LAA exclusion to those who did not. Moreover, we analyzed the role of 
      preoperative AF duration (</= or >1 year) and medial-lateral left atrial dimensions 
      (ML-LAD) (</= or >6 cm). The efficacy endpoint was freedom from AF at discharge and 
      at 2-year follow-up. The safety endpoints were need of a permanent pacemaker 
      (PMK), surgical re-exploration, occurrence of stroke, and left circumflex artery 
      or esophageal lesions. RESULTS: Overall, the rate of AF freedom was 69% at 
      discharge and 80% at 2-year follow-up. LAA exclusion did not influence AF freedom 
      at 2-year follow-up, and 84.6% of patients who underwent LAA exclusion were in 
      the sinus rythm (SR) at 2 year compared to 75% of those who did not receive LAA 
      exclusion free from AF as well (p=0.230). AF duration </=1 or >1 year did not 
      influence sinus rhythm (SR) maintenance (85.7% vs. 75.8%; p=0.224), and in these 
      two groups, LAA exclusion did not change the efficacy of AFSA. ML-LAD </= 6 cm was 
      associated with better results in terms of SR maintenance. A statistically 
      significant association between LAA exclusion and SR maintenance at 2-year 
      follow-up (p=0.017) was found among patients with ML-LAD </= 6 cm. Complications 
      included 7 cases of PMK implantation, 2 cases of surgical re-exploration, and 1 
      case of stroke. No circumflex artery or esophageal lesions occurred after 
      surgical procedures. CONCLUSIONS: In our experience, AFSA during isolated MVS 
      resulted in good outcomes in terms of SR maintenance and incidence of 
      complications. AF duration </= 1 year did not influence results, while patients 
      with ML-LAD </= 6 cm had significantly better results regarding SR at follow-up. In 
      patients with ML-LAD </= 6 cm, LAA exclusion significantly increased the success 
      rate of SR maintenance at 2-year follow-up.
CI  - Copyright (c) 2021 C. Lavalle et al.
FAU - Lavalle, C
AU  - Lavalle C
AD  - Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, 
      Policlinico Umberto I Hospital, Rome, Italy.
FAU - Straito, M
AU  - Straito M
AD  - Department of Clinical Internal, Anaesthesiology and Cardiovascular Sciences, 
      "Sapienza" University of Rome, Rome, Italy.
FAU - Chourda, E
AU  - Chourda E
AD  - Department of Clinical Internal, Anaesthesiology and Cardiovascular Sciences, 
      "Sapienza" University of Rome, Rome, Italy.
FAU - Poggi, S
AU  - Poggi S
AD  - Department of Clinical Internal, Anaesthesiology and Cardiovascular Sciences, 
      "Sapienza" University of Rome, Rome, Italy.
FAU - Frati, G
AU  - Frati G
AD  - Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University 
      of Rome, Rome, Italy.
AD  - IRCCS NEUROMED, Pozzilli, Italy.
FAU - Saade, W
AU  - Saade W
AUID- ORCID: 0000-0001-6617-6103
AD  - Department of Clinical Internal, Anaesthesiology and Cardiovascular Sciences, 
      "Sapienza" University of Rome, Rome, Italy.
FAU - Marullo, A G M
AU  - Marullo AGM
AD  - Department of Medico-Surgical Sciences and Biotechnologies, "Sapienza" University 
      of Rome, Rome, Italy.
FAU - Mariani, M V
AU  - Mariani MV
AD  - Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, 
      Policlinico Umberto I Hospital, Rome, Italy.
FAU - Magnocavallo, M
AU  - Magnocavallo M
AD  - Cardio Thoracic-Vascular and Organ Transplantation Surgery Department, 
      Policlinico Umberto I Hospital, Rome, Italy.
FAU - Miraldi, F
AU  - Miraldi F
AD  - Department of Clinical Internal, Anaesthesiology and Cardiovascular Sciences, 
      "Sapienza" University of Rome, Rome, Italy.
LA  - eng
PT  - Journal Article
DEP - 20210802
PL  - United States
TA  - Cardiol Res Pract
JT  - Cardiology research and practice
JID - 101516542
PMC - PMC8355965
COIS- The authors declare that they have no conflicts of interest.
EDAT- 2021/08/17 06:00
MHDA- 2021/08/17 06:01
PMCR- 2021/08/02
CRDT- 2021/08/16 05:57
PHST- 2021/03/30 00:00 [received]
PHST- 2021/06/01 00:00 [revised]
PHST- 2021/07/27 00:00 [accepted]
PHST- 2021/08/16 05:57 [entrez]
PHST- 2021/08/17 06:00 [pubmed]
PHST- 2021/08/17 06:01 [medline]
PHST- 2021/08/02 00:00 [pmc-release]
AID - 10.1155/2021/9999412 [doi]
PST - epublish
SO  - Cardiol Res Pract. 2021 Aug 2;2021:9999412. doi: 10.1155/2021/9999412. 
      eCollection 2021.