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The Importance of Addressing Atrial Fibrillation During Concomitant Cardiac Surgery

Year 2020, Volume: 23 Issue: 2, 141 - 143, 16.08.2020

Abstract

A long-term maintenance of sinus rhythm in patients undergoing cardiac surgery with atrial fibrillation is only possible with concomitant Cox-Maze IV procedure. Contemporary studies suggest that concomitant biatrial lesion sets produce long-term sinus conversion rates of up to 90%. This procedure holds the potential to improve life quality and even survival of the patients; however, many surgeons are reluctant to perform the same. More than half of the patients with atrial fibrillation undergoing cardiac surgery for different reasons never receive any kind of intervention for atrial fibrillation, which means missing a once-in-a-lifetime opportunity to treat atrial fibrillation. Rate control with anticoagulation remains the only alternative treatment for these patients. Anticoagulation can be a relatively safe option at the time of surgery but may become dangerous or even a contraindication with the patient’s increasing age and a possible development of new diseases. Sinus rhythm can become lifesaving at that point. The objective of this report is to describe a successful surgical treatment of a 74-year-old woman with severe mitral and tricuspid valve insufficiency along with atrial fibrillation. She had mild leucopenia and anemia at the time of surgery without any hematological diagnosis. She was diagnosed with myelodysplastic syndrome six months after the surgery. In addition to valve repairs, the maintenance of sinus rhythm prompted hematologists to treat her without using any anticoagulation medicines. We believe that atrial fibrillation should be addressed during cardiac surgery because the maintenance of sinus rhythm might become crucial during follow-up!

References

  • 1. Odenike O, Anastasi J, Le Beau MM. Myelodysplastic syndromes. Clin Lab Med 2011;31:763-84.
  • 2. Omoto T, Hirota M, Ishikawa N, Tedoriya T. Mitral valve repair in a patient with myelodysplastic syndrome. Ann Thorac Cardiovasc Surg 2011;17:614-7.
  • 3. Adademir T, Khiabani AJ, Schill MR, Sinn LA, Schuessler RB, Moon MR, et al. Surgical ablation of atrial fibrillation in patients with tachycardia-induced cardiomyopathy. Ann Thorac Surg 2019;108:443-50.
  • 4. Badhwar V, Rankin JS, Ad N, Grau-Sepulveda M, Damiano RJ, Gillinov AM, et al. Surgical ablation of atrial fibrillation in the United States: trends and propensity matched outcomes. Ann Thorac Surg 2017;104:493-500.
  • 5. Czader M, Orazi A. World Health Organization classification of myelodysplastic syndromes. Curr Pharm Des 2012;18:3149-62.
  • 6. Yamagishi T, Fuse K, Saito T, Kato M, Misawa Y, Kamisawa O, et al. Successful coronary artery bypass grafting for a patient with myelodysplastic syndrome: report of a case. Surgery Today 1996;26:740-3.
  • 7. Taguchi T, Nishi H, Kurose K, Horikawa K, Kanazawa G, Takahashi T. Minimally invasive mitral valve repair via right mini-thoracotomy in patient with myelodysplastic syndrome. J Cardiothorac Surg 2018;13:45.
  • 8. Schaff HV, Dearani JA, Daly RC, Orszulak TA, Danielson GK. Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience. Semin Thorac Cardiovasc Surg 2000;12:30-7.

Kalp Cerrahisi Sırasında Eşlik Eden Atriyal Fibrilasyonun Hedef Alınmasının Önemi

Year 2020, Volume: 23 Issue: 2, 141 - 143, 16.08.2020

Abstract

Kalp operasyonu geçirecek olan atriyal fibrilasyonlu hastalarda uzun süreli sinüs ritminin korunması sadece eşlik eden Cox Maze IV operasyonu ile mümkündür. Güncel çalışmalar, eş zamanlı bi-atriyal lezyon setleri yapılan hastalarda %90’a kadar uzun süreli sinüs ritmi sağlandığını göstermektedir. Bunun yaşam kalitesini artırma ve hatta hastaların yaşam sürelerini uzatma potansiyeli vardır; ancak birçok cerrah bu prosedürü uygulama konusunda isteksizdir. Farklı nedenlerle kalp cerrahisi geçiren atriyal fibrilasyon hastalarının yarısından fazlasında atriyal fibrilasyon için herhangi bir müdahale yapılmaz. Bu, atriyal fibrilasyonu tedavi etmek için tek fırsatı kullanmamak anlamına gelir. Antikoagülan ilaçlar ve hız kontrolü, bu hastalar için kalan tek tedavi yöntemidir. Antikoagülasyon, ameliyat döneminde nispeten güvenli bir seçenek olabilir, ancak hastanın artan yaşı ve gelişebilecek yeni hastalıkları ile tehlikeli veya hatta kontrendike olabilir. Sinüs ritmi bu noktada hayat kurtarıcı olabilir. Burada ciddi mitral, triküspit kapak yetmezliği ve atriyal fibrilasyonu olan 74 yaşında bir kadın hastanın başarılı cerrahi tedavisi sunulmaktadır. Ameliyat sırasında hematolojik tanısı olmayan hastada, hafif lökopeni ve anemi mevcuttu. Hastaya ameliyattan altı ay sonra miyelodisplastik sendrom tanısı konuldu. Kapak onarımına ek olarak, sinüs ritminin sağlanması, hematologların tedavisini antikoagülasyonsuz yapabilmesini sağladı. Atriyal fibrilasyonun kardiyak cerrahi sırasında düzeltilmesi gerektiğine inanıyoruz, çünkü sinüs ritminin devamı zamanla daha da önemli olabilir.

References

  • 1. Odenike O, Anastasi J, Le Beau MM. Myelodysplastic syndromes. Clin Lab Med 2011;31:763-84.
  • 2. Omoto T, Hirota M, Ishikawa N, Tedoriya T. Mitral valve repair in a patient with myelodysplastic syndrome. Ann Thorac Cardiovasc Surg 2011;17:614-7.
  • 3. Adademir T, Khiabani AJ, Schill MR, Sinn LA, Schuessler RB, Moon MR, et al. Surgical ablation of atrial fibrillation in patients with tachycardia-induced cardiomyopathy. Ann Thorac Surg 2019;108:443-50.
  • 4. Badhwar V, Rankin JS, Ad N, Grau-Sepulveda M, Damiano RJ, Gillinov AM, et al. Surgical ablation of atrial fibrillation in the United States: trends and propensity matched outcomes. Ann Thorac Surg 2017;104:493-500.
  • 5. Czader M, Orazi A. World Health Organization classification of myelodysplastic syndromes. Curr Pharm Des 2012;18:3149-62.
  • 6. Yamagishi T, Fuse K, Saito T, Kato M, Misawa Y, Kamisawa O, et al. Successful coronary artery bypass grafting for a patient with myelodysplastic syndrome: report of a case. Surgery Today 1996;26:740-3.
  • 7. Taguchi T, Nishi H, Kurose K, Horikawa K, Kanazawa G, Takahashi T. Minimally invasive mitral valve repair via right mini-thoracotomy in patient with myelodysplastic syndrome. J Cardiothorac Surg 2018;13:45.
  • 8. Schaff HV, Dearani JA, Daly RC, Orszulak TA, Danielson GK. Cox-Maze procedure for atrial fibrillation: Mayo Clinic experience. Semin Thorac Cardiovasc Surg 2000;12:30-7.
There are 8 citations in total.

Details

Primary Language English
Subjects Clinical Sciences
Journal Section Case Reports
Authors

Ahmet Zengin This is me 0000-0002-9917-2181

Taylan Adademir This is me 0000-0003-1643-3751

Kaan Kırali This is me 0000-0003-0044-4691

Publication Date August 16, 2020
Published in Issue Year 2020 Volume: 23 Issue: 2

Cite

Vancouver Zengin A, Adademir T, Kırali K. The Importance of Addressing Atrial Fibrillation During Concomitant Cardiac Surgery. Koşuyolu Heart Journal. 2020;23(2):141-3.