Left Atrial Reduction Plasty and Sinus Rhythm Restoration in patients undergoing Mitral Valve Surgery with Chronic Atrial Fibrillation

Abstract

Objective: To assess outcome of Left Atrial reduction plasty and sinus rhythm restoration in patients undergoing Mitral valve surgery with chronic Atrial Fibrillation.

Study Design: Longitudinal study.

Place and Duration of Study: Adult Cardiac Surgery Unit, Armed Forces Institute of Cardiology/National Institute of Heart
Diseases, Rawalpindi Pakistan, from Jan 2017-Jun 2022.

Methodology: Thirty three (n=33) patients with mitral valve disease were recruited via convenience sampling, all of whom
exhibited an enlarged left atrium and pre-operative Atrial Fibrillation (AF). Pre-operative cardiac evaluations were performed using Transthoracic Echocardiography (TTE). Pre- and post-surgery trans-esophageal echocardiography studies were conducted as a routine procedure. Follow-up echocardiographic assessments were carried out at intervals of 1 month, 3 months, and 6 months, alongside Electrocardiograms (ECGs). During surgery, median sternotomy was done.
Cardiopulmonary Bypass (CPB) time was established followed by cardiac arrest. After Mitral valve Repair/Replacement
(MVR), Left Atrial (LA) plication was done by a double needle.

Results: Out of thirty three (n=33) patients, 25(75.7%) females and 8(24.2%) male patients, with mean age of 44.3±15.5 years, underwent mitral valve surgery(repair/replacement) followed by LA reduction & sinus rhythm restoration procedure.
Complete restoration of sinus rhythm with re-appearance of “a” wave on echocardiography, signifying LA transport function
through mitral valve was observed in 31(93.9%) patients on 3rd month and only 1(3.0%) individual continued to have
persistent AF after 6 months. (83.70±2.50 mm vs. 47.50±1.08 mm) (p<0.001)..................

Conclusion: Left atrial reduction by “Plication technique” followed by “Diathermy Fulguration” as a part of mitral valve
surgery has yielded ...............