Beyond the Chamber: Left Atrial Diameter Index Shapes Outcome in Valve Surgery

Area of Science:

• Cardiovascular Medicine
• Cardiac Surgery
• Clinical Outcomes Research

Background:

• Left atrial enlargement is a known risk factor for adverse cardiovascular outcomes.
• The specific impact of preoperative left atrial size on early outcomes following valve replacement surgery is not fully understood.

Purpose of the Study:

• To investigate the association between preoperative left atrial diameter index (LADI) and early morbidity and mortality after aortic and/or mitral valve replacement (MVR).
• To determine if LADI is an independent predictor of postoperative complications.

Main Methods:

• Retrospective review of 422 patients undergoing valve replacement for rheumatic heart disease between 2004 and 2022.
• Preoperative LADI measurement and classification into normal (<2.3 cm/m²) or abnormal (≥2.3 cm/m²).
• Comparison of clinical, operative, and postoperative outcomes, including 30-day mortality, postoperative atrial fibrillation (POAF), neurological events, renal impairment, bleeding, and pacing wire requirement.

Main Results:

• Nearly half of patients (48.8%) had abnormal LADI, more frequently undergoing MVR.
• Abnormal LADI was significantly associated with increased rates of POAF (16.0% vs. 7.4%) and intraoperative pacing wire insertion (38.3% vs. 23.5%).
• Multivariate analysis identified severe LADI as an independent predictor of POAF (OR 3.91) and pacing requirements (OR 2.31), but not 30-day mortality or other major complications.

Conclusions:

• Preoperative left atrial diameter index is an independent predictor of postoperative arrhythmic complications and pacing needs after valve replacement.
• LADI does not appear to predict early mortality after valve replacement surgery.
• Incorporating LADI into preoperative risk stratification may enhance rhythm surveillance and perioperative planning for patients undergoing valve replacement.