Surgical Atrial Compartimentalization for Chronic Atrial Fibrillation in Mitral Valve

pp 371-377

Abstract

Background

After mitral valve operations atrial fibrillation recurs in most patients, consequently classical mitral valve surgery rarely eliminates the loss of atrial kick and the risk of stroke.

Objectives

To present our initial experience with surgical atrial compartimentalization, to compare the mortality and morbidity rates with those of the mitral valve surgery and to assess its effectiveness in maintaining sinus rhythm at six months.

Methods

We compared eleven patients with chronic atrial fibrillation and mitral surgery (Group A) and seven patients with concomitant surgical atrial compartimentalization (GroupB)by clinical and electrocardiographic controls. Those with successful cardioversion were studied with P-wave signal average ECG and Doppler echocardiography within the first week, at three and at six months. Statistical analysis was performed using chi square, Fisher's, Student's t and Kruskal-Wallis tests

Results

Surgical atrial compartimentalization prolonged cardiopulmonary bypass time(82.7 ± 21 vs 130.528.3 minutes; p = 0.006) with no increase in morbidity, or the hospital lenght of stay. Immediate restoration of sinus rhythm and recurrence of atrial fibrillation were high in both groups (50% vs 71.4% and 70% vs 85.7%; p = ns).Conversion of the recurrence and six months maintenance of sinus rhythm were higher in groupB(0% vs 66.6%, p = 0.01 and20% vs 71.4%, p = 0.058). Recovery of atrial mechanical function was as higher in the right than in the left atrium (66.6% vs 16.6%).

Conclusions

Surgical atrial compartimentalization is a safe and effective treatment for chronic atrial fibrillation in mitral valve disease, it does not increase morbidity or lenght of stay compared with mitral surgery and the six months maintenance of sinus rhythm is high.