Akira Marui, Keiichi Tambara, Yoshiaki Saji, Nozomu Sasahashi, Tadashi Ikeda, Takeshi Nishina, Masashi Komeda; Kyoto University Graduate School of Medicine, Kyoto, Japan
Objective: LA-VR concomitant with MAZE is reported to facilitate sinus rhythm (SR) recovery even in patients with refractory atrial fibrillation (AF) with enlarged LA. However, little is known about the postoperative functional recovery of the enlarged LA with overstretched myocardium. Here, we focused on 2 important LA functions; booster (systolic) and reservoir (diastolic) functions, and evaluated them by MRI to obtain more accurate cardiac geometry and functions than UCG.Methods: MAZE in association with mitral valve surgery was performed in 42 AF patients with enlarged LA (diameter = 60 mm). Among them, 23 patients had concomitant LA-VR (VR group) while 19 did not have LA-VR (Control group). LA volume (LAV)-time curves were depicted by plotting each instantaneous LAV against the time after the R-wave of ECG (Figure). LA booster function was calculated as the % decrease from volume D to A, and reservoir function was that from B to C.
Results: (Table) Preoperatively, maximum/minimum LAV and LVEF were similar between the groups. Postoperatively, in the VR group, SR recovery rate was better (87% vs. 68%, p<0.05) and maximum LAV was drastically reduced by the LA-VR (‡p<0.001), which was also far smaller than that in the Control (**p<0.001). Most importantly, among the patients with SR recovery in either group, postoperative booster and resorvoir function in the VR were far better than those in the Control (**p<0.001 each). Furthermore, LVEF improved, and LVEDV reduced only in the VR (†p<0.01, respectively).
Conclusion: LA-VR concomitant with MAZE helped restore both booster and reservoir functions of the enlarged LA. Furthermore, the procedure contributed to restoration of LV geometry and fucntion. However, even in patients with SR recovery, MAZE without LA-VR did not restore the functions of enlarged LA with less improvement of LVEF. LA-VR may be essential to improve LA/LV geometry and functions in patients with refractory AF with enlarged LA.
Back to Annual Meeting
Back to Program Outline
