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Impact of left atrium plication on chronic heart failure with atrial functional mitral regurgitation

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Indian Journal of Thoracic and Cardiovascular Surgery Aims and scope Submit manuscript

Abstract

Purpose

We hypothesized that a giant left atrium may oppress  the posterior left ventricle and aggravate diastolic dysfunction and heart failure. We evaluated the effect of left atrial plication (LAP) on atrial functional mitral regurgitation.

Methods

We retrospectively reviewed patients who underwent LAP for atrial functional mitral regurgitation at our institution between January 2017 and December 2021. Early outcomes, follow-up echocardiography data, and heart failure indicators were compared.

Results

Eighteen patients were divided into two groups: LAP + (n = 9) or LAP- (n = 9). There were no significant differences in patient characteristics and preoperative echocardiographic parameters, except for the preoperative New York Heart Association classification. Operative (505.7 [standard deviation: 100.0] minutes vs. 382.9 [standard deviation: 58.1] minutes, P = .0055) and cardiopulmonary bypass times (335.6 [standard deviation: 50.4] minutes vs. 246.9 [standard deviation: 62.7] minutes, P = .0044) were significantly longer in the LAP + group. No in-hospital mortalities were observed in both groups. The postoperative left atrial volume was significantly reduced in the LAP + group, and mitral regurgitation was controlled at less than mild levels in both groups. At follow-up, the left ventricular end-diastolic volume was reduced significantly in the LAP + group. Brain natriuretic peptide, cardiothoracic ratio, and the New York Heart Association classification were improved in the LAP + group.

Conclusions

Additional left atrial plication contributes to the control of atrial functional mitral regurgitation and heart failure at a later stage. A careful long-term follow-up is needed as re-expansion of the left atrium is possible.

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Data availability

The data underlying this article are available in the article.

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Acknowledgements

We are grateful to Miharu Kojo for the data collection and to Editage (www.editage.com) for the English language editing.

Funding

No funds, grants, or other support was received.

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Authors and Affiliations

  1. Division of Cardiovascular Surgery, Saiseikai Kumamoto Hospital, 5-3-1, Cikami, Minami-Ku, Kumamoto, 861-4193, Japan

    Kosuke Nakamae, Takashi Oshitomi, Hideyuki Uesugi, Ichiro Ideta, Kentaro Takaji, Toshiharu Sassa, Hidetaka Murata & Masataka Hirota

Authors
  1. Kosuke Nakamae
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  2. Takashi Oshitomi
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  3. Hideyuki Uesugi
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  4. Ichiro Ideta
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  7. Hidetaka Murata
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  8. Masataka Hirota
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Contributions

K. Nakamae conceptualized the idea of the manuscript. K. Nakamae and M. Hirota curated the data, and K. Nakamae originally drafted the manuscript. H. Murata, T. Sassa, K. Takaji, and I. Ideta verified the analytical method. T. Oshitomi and H. Uesugi supervised this study. All authors discussed the results and contributed to the final manuscript.

Corresponding author

Correspondence to Kosuke Nakamae.

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Human and animal rights statement

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Ethics approval

All procedures performed in this study involving human participants were in accordance with the ethical standards of the institutional or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards. The study was approved by the Institutional Review Board of Saiseikai Kumamoto Hospital (3/2/2022, 1061).

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The authors have no competing interests to declare that are relevant to the content of this article.

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The requirement for informed consent was waived because of the retrospective and observational nature of the study.

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Nakamae, K., Oshitomi, T., Uesugi, H. et al. Impact of left atrium plication on chronic heart failure with atrial functional mitral regurgitation. Indian J Thorac Cardiovasc Surg 40, 24–32 (2024). https://doi.org/10.1007/s12055-023-01569-6

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  • DOI: https://doi.org/10.1007/s12055-023-01569-6

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