Related Experiment Videos
Left atrial function after Cox's maze operation concomitant with mitral valve operation
Insights
Concomitant maze operations with mitral valve surgery may not eliminate atrial fibrillation in elderly patients, showing incomplete left atrial contraction. This impacts ventricular filling and atrial function post-surgery.
Area of Science:
- Cardiology
- Cardiac Surgery
- Electrophysiology
Background:
- Atrial fibrillation is a common complication following mitral valve operations.
- The study investigates the efficacy of a concomitant maze operation in preventing atrial fibrillation.
- Mitral valve surgery often leads to atrial fibrillation, impacting patient outcomes.
Purpose of the Study:
- To evaluate left atrial function after a Cox's maze operation performed concurrently with mitral valve surgery.
- To assess the impact of concomitant maze procedures on atrial contractility and ventricular filling.
- To determine if the maze procedure eliminates atrial fibrillation in this patient cohort.
Main Methods:
- Transthoracic echocardiography was used to assess left atrial function in 10 patients (38-67 years) undergoing combined mitral valve and maze operations.
- Key indices measured included the A/E ratio and atrial filling fraction (AFF) from transmitral flow.
- A control group of 7 patients who had undergone coronary artery bypass grafting was included for comparison.
Main Results:
- Patients who had the concomitant maze operation showed significantly lower A/E ratios and AFF compared to controls.
- Both A/E ratio and AFF correlated inversely with age in the maze group.
- The maze group exhibited a larger left atrial volume index and reduced active emptying volume index.
Conclusions:
- Left atrial contraction is detectable but incomplete in elderly patients after a concomitant maze and mitral valve operation.
- The procedure may not fully restore atrial function, particularly in older individuals with dilated atria.
- Further research is needed to optimize maze procedures for preventing atrial fibrillation post-mitral valve surgery.
Background:
This study examined whether the atrial fibrillation that commonly occurs in patients with a mitral valve operation could be eliminated by a concomitant maze operation.
Methods:
Left atrial function after Cox's maze operation performed concomitantly with a mitral valve operation was evaluated in 10 patients ranging in age from 38 to 67 years (mean age, 54 years). Seven patients who had had coronary artery bypass grafting served as the control group. Using transthoracic echocardiography, the ratio between the peak speed of the early filling wave and that of the atrial contraction wave (A/E ratio) and the atrial filling fraction (AFF) were determined from transmitral flow measurements. These two indices have been considered to represent the contribution of left atrial active contraction to ventricular filling.
Results:
The A/E ratio and the AFF were significantly lower in the maze group (0.35 +/- 0.17 versus 0.97 +/- 0.28 [p < 0.01] and 17.6% +/- 8.8% versus 36.8% +/- 6.4% [p < 0.01], respectively). The A/E ratio and the AFF correlated inversely with age (r = -0.72, p < 0.05 and r = 0.76, p < 0.05, respectively) in the maze group. In an angiographic study, the mean left atrial maximal volume index in the maze group was approximately three times larger than that in the control group (117.5 +/- 24.3 mL/m2 versus 35.3 +/- 6.6 mL/m2 [p < 0.01]). The left atrial active emptying volume index was significantly smaller in patients in the maze group (7.2 +/- 2.5 mL/m2 versus 13.1 +/- 4.6 mL/m2 [p < 0.01]).
Conclusions:
After the maze procedure performed concomitantly with a mitral valve operation in patients with a dilated left atrium, left atrial contraction is detectable but incomplete in the elderly.