{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,12]],"date-time":"2025-10-12T03:48:38Z","timestamp":1760240918382,"version":"build-2065373602"},"reference-count":37,"publisher":"MDPI AG","issue":"10","license":[{"start":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T00:00:00Z","timestamp":1571616000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"name":"Progetti di Ricerca finanziati dall\u2019Universit\u00e0 degli Studi di Torino (ex 60%) \u2013 anno 2015\u201d;","award":["CONTRACTION Pilot Trial \u2013 Cryoablation effects ON ThRomboembolic risk and Atrial funCTION"],"award-info":[{"award-number":["CONTRACTION Pilot Trial \u2013 Cryoablation effects ON ThRomboembolic risk and Atrial funCTION"]}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Medicina"],"abstract":"<jats:p>Background and Objectives: Surgical atrial fibrillation (AF) ablation concomitant to minimally invasive mitral valve repair has been proven to offer improved short- and long-term sinus rhythm (SR) maintenance compared to mitral valve surgery only. The objective of the present study was to explore, by thorough echocardiographic assessment, long-term morphological and functional left atrial (LA) outcomes after this combined surgical procedure. Materials and Methods: From October 2006 to November 2015, 48 patients underwent minimally invasive mitral valve repair and concomitant surgical AF cryoablation. Results: After 3.8 \u00b1 2.2 years, 30 (71.4%) of those completing the follow-up (n = 42, 87.5%) presented SR. During follow-up, four (9.5%) patients suffered from cerebrovascular accidents and two of these subjects had a long-standing persistent AF relapse and were in AF at the time of the event, while the other two were in SR. An echocardiographic study focused on LA characteristics was performed in 29 patients (69.0%). Atrial morphology and function (e.g., maximal LA volume indexed to body surface area and total LA emptying fraction derived from volumes) in patients with stable SR (60.6 \u00b1 13.1 mL\/mq and 25.1 \u00b1 7.3%) were significantly better than in those with AF relapses (76.8 \u00b1 16.2 mL\/mq and 17.5 \u00b1 7.4%; respectively, p = 0.008 and p = 0.015). At follow-up, patients who suffered from ischemic cerebral events had maximal LA volume indexed to body surface area 61 \u00b1 17.8 mL\/mq, with total LA emptying fraction derived from volumes 23.6 \u00b1 13.7%; patients with strokes in SR showed very enlarged LA volume (&gt;70 mL\/mq). Conclusions: AF cryoablation concomitant with minimally invasive mitral valve repair provides a high rate of SR maintenance and this relates to improved long-term morphological and functional LA outcomes. Further prospective studies are needed to define the cut-off values determining an increase in the risk for thromboembolic complications in patients with restored stable SR.<\/jats:p>","DOI":"10.3390\/medicina55100709","type":"journal-article","created":{"date-parts":[[2019,10,21]],"date-time":"2019-10-21T11:37:55Z","timestamp":1571657875000},"page":"709","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Left Atrial Function after Atrial Fibrillation Cryoablation Concomitant to Minimally Invasive Mitral Valve Repair: A Pilot Study on Long-Term Results and Clinical Implications"],"prefix":"10.3390","volume":"55","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-6311-4270","authenticated-orcid":false,"given":"Matteo","family":"Anselmino","sequence":"first","affiliation":[{"name":"Division of Cardiology, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, Department of Medical Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4815-9427","authenticated-orcid":false,"given":"Chiara","family":"Rovera","sequence":"additional","affiliation":[{"name":"Cardiology Unit, \u201cOspedale Civico\u201d, Chivasso, 10034 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Giovanni","family":"Marchetto","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Davide","family":"Castagno","sequence":"additional","affiliation":[{"name":"Division of Cardiology, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, Department of Medical Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mara","family":"Morello","sequence":"additional","affiliation":[{"name":"Division of Cardiology, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, Department of Medical Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Simone","family":"Frea","sequence":"additional","affiliation":[{"name":"Division of Cardiology, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, Department of Medical Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fiorenzo","family":"Gaita","sequence":"additional","affiliation":[{"name":"Cardiology Department, Clinica Pinna Pintor, 10129 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Mauro","family":"Rinaldi","sequence":"additional","affiliation":[{"name":"Division of Cardiac Surgery, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gaetano Maria","family":"De Ferrari","sequence":"additional","affiliation":[{"name":"Division of Cardiology, \u201cCitt\u00e0 della Salute e della Scienza di Torino\u201d Hospital, Department of Medical Sciences, University of Turin, 10124 Torino, Italy"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2019,10,21]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"408","DOI":"10.1016\/S0022-5223(12)70085-5","article-title":"Outcome of mitral valve repair in patients with preoperative atrial fibrillation. Should the maze procedure be combined with mitral valvuloplasty?","volume":"107","author":"Chua","year":"1994","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e2240","DOI":"10.7717\/peerj.2240","article-title":"Computational fluid dynamics modelling of left valvular heart diseases during atrial fibrillation","volume":"4","author":"Scarsoglio","year":"2016","journal-title":"PeerJ"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"1273","DOI":"10.1016\/j.athoracsur.2013.05.054","article-title":"Very long-term results of surgical and transcatheter ablation of long-standing persistent atrial fibrillation","volume":"96","author":"Gaita","year":"2013","journal-title":"Ann. Thorac. Surg."},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"434","DOI":"10.1016\/j.athoracsur.2007.04.036","article-title":"Influence of preoperative atrial fibrillation on late results of mitral repair: Is concomitant ablation justified?","volume":"84","author":"Ngaage","year":"2007","journal-title":"Ann. Thorac. Surg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"773","DOI":"10.1016\/S0022-5223(97)70081-3","article-title":"Video-assisted minimally invasive mitral valve surgery","volume":"114","author":"Chitwood","year":"1997","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1053\/j.semtcvs.2016.04.006","article-title":"Results of cryoablation for atrial fibrillation concomitant with video-assisted minimally invasive mitral valve surgery","volume":"28","author":"Marchetto","year":"2016","journal-title":"Semin. Thorac. Cardiovasc. Surg."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"1465","DOI":"10.1056\/NEJMe1501493","article-title":"Surgical ablation of atrial fibrillation\u2014When, why, and how?","volume":"372","author":"Schaff","year":"2015","journal-title":"N. Engl. J. Med."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"2902","DOI":"10.1093\/eurheartj\/ehm378","article-title":"A randomized doubleblind study of epicardial left atrial cryoablation for permanent atrial fibrillation in patients undergoing mitral valve surgery: The SWEDish Multicentre Atrial Fibrillation study (SWEDMAF)","volume":"28","author":"Johansson","year":"2007","journal-title":"Eur. Heart J."},{"key":"ref_9","first-page":"3","article-title":"Systematic review and meta-analysis of surgical ablation for atrial fibrillation during mitral valve surgery","volume":"3","author":"Phan","year":"2014","journal-title":"Ann. Cardiothorac. Surg."},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"298","DOI":"10.1016\/j.jtcvs.2015.09.098","article-title":"The cardiac surgeon as electrophysiologist","volume":"151","author":"Stulak","year":"2016","journal-title":"J. Thorac. Cardiovasc. Surg."},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"1317","DOI":"10.1016\/j.amjcard.2009.12.046","article-title":"Meta-analysis of the effect of radiofrequency catheter ablation on left atrial size, volumes and function in patients with atrial fibrillation","volume":"105","author":"Jeevanantham","year":"2010","journal-title":"Am. J. Cardiol."},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1080\/14779072.2017.1332993","article-title":"Anticoagulant cessation following atrial fibrillation ablation: Limits of the ECG-guided approach","volume":"15","author":"Anselmino","year":"2017","journal-title":"Expert Rev. Cardiovasc. Ther."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"1989","DOI":"10.1016\/j.athoracsur.2016.04.104","article-title":"Right minithoracotomy for mitral valve surgery: Impact of tailored strategies on early outcome","volume":"102","author":"Barbero","year":"2016","journal-title":"Ann. Thorac. Surg."},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"58","DOI":"10.1016\/j.athoracsur.2016.05.093","article-title":"Left-sided surgical ablation for patients with atrial fibrillation who are undergoing concomitant cardiac surgical procedures","volume":"103","author":"Ad","year":"2017","journal-title":"Ann. Thorac. Surg."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"336","DOI":"10.1016\/S0002-9149(83)80061-7","article-title":"Normal left atrial function determined by 2-dimensional echocardiography","volume":"51","author":"Gutman","year":"1983","journal-title":"Am. J. Cardiol."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"617","DOI":"10.1016\/0735-1097(89)90602-5","article-title":"Pulsed Doppler evaluation of atrial mechanical function after electrical cardioversion of atrial fibrillation","volume":"13","author":"Manning","year":"1989","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"820","DOI":"10.1016\/S0735-1097(02)02921-2","article-title":"Peak early diastolic mitral annulus velocity by tissue Doppler imaging adds independent and incremental prognostic value","volume":"41","author":"Wang","year":"2003","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"152","DOI":"10.11152\/mu.201.3.2066.162.sl1am2","article-title":"Left atrium function assessment by echocardiography\u2014physiological and clinical implications","volume":"16","author":"Lupu","year":"2014","journal-title":"Med. Ultrason."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"1079","DOI":"10.1016\/S0002-9149(03)00152-8","article-title":"Doppler transmitral flow indexes and risk of atrial fibrillation (the Framingham Heart Study)","volume":"91","author":"Vasan","year":"2003","journal-title":"Am. J. Cardiol."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1122","DOI":"10.1111\/echo.12817","article-title":"Early improvement in left atrial remodeling and function after mitral valve repair or replacement in organic symptomatic mitral regurgitation assessed by three-dimensional echocardiography","volume":"32","author":"Barretto","year":"2015","journal-title":"Echocardiography"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"225","DOI":"10.1016\/j.jcmg.2013.12.009","article-title":"Atrial function as a guide to timing of intervention in mitral valve prolapse with mitral regurgitation","volume":"7","author":"Ring","year":"2014","journal-title":"JACC Cardiovasc. Imaging"},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"765921","DOI":"10.1155\/2015\/765921","article-title":"Echocardiographic evaluation of left atrial mechanics: Function, history, novel techniques, advantages, and pitfalls","volume":"2015","author":"Leischik","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"247","DOI":"10.1111\/j.1540-8167.2011.02177.x","article-title":"Left atrial deformation imaging with ultrasound based two-dimensional speckle-tracking predicts the rate of recurrence of paroxysmal and persistent atrial fibrillation after successful ablation procedures","volume":"23","author":"Hammerstingl","year":"2012","journal-title":"J. Cardiovasc. Electrophysiol."},{"key":"ref_24","first-page":"II285","article-title":"Restoration of atrial function after the maze procedure for patients with atrial fibrillation: Assessment by Doppler echocardiography","volume":"90","author":"Feinberg","year":"1994","journal-title":"Circulation"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1097","DOI":"10.1016\/S0735-1097(98)00058-8","article-title":"Comparative efficacy of the maze procedure for restoration of atrial contraction in patients with and without giant left atrium associated with mitral valve disease","volume":"31","author":"Yuda","year":"1998","journal-title":"J. Am. Coll. Cardiol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"7","DOI":"10.1007\/s12262-012-0724-0","article-title":"Left atrial and left ventricular diastolic function after the maze procedure for atrial fibrillation in mitral valve disease: Degenerative versus rheumatic","volume":"77","author":"Kim","year":"2015","journal-title":"Indian J. Surg."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"274817","DOI":"10.1155\/2015\/274817","article-title":"Surgical treatment of concomitant atrial fibrillation: Focus onto atrial contractility","volume":"2015","author":"Loardi","year":"2015","journal-title":"Biomed. Res. Int."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"609","DOI":"10.1510\/icvts.2009.208173","article-title":"Restoration of atrial contractility after surgical cryoablation: Clinical, electrical and mechanical results","volume":"9","author":"Reyes","year":"2009","journal-title":"Interact. Cardiovasc. Thorac. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"731","DOI":"10.1016\/S1010-7940(03)00496-2","article-title":"Cryoablation of the left posterior atrial wall: 95 patients and 3 years of mean follow-up","volume":"24","author":"Manasse","year":"2003","journal-title":"Eur. J. Cardiothorac. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"85","DOI":"10.1007\/s10840-011-9605-x","article-title":"Atrial function after left atrial epicardial cryoablation for atrial fibrillation in patients undergoing mitral valve surgery","volume":"33","author":"Johansson","year":"2012","journal-title":"J. Interv. Card. Electrophysiol."},{"key":"ref_31","doi-asserted-by":"crossref","first-page":"528","DOI":"10.1016\/j.amjcard.2008.10.021","article-title":"Differential recovery of regional atrial contraction after restoration of sinus rhythm after intraoperative linear radiofrequency ablation for atrial fibrillation","volume":"103","author":"Boyd","year":"2009","journal-title":"Am. J. Cardiol."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"31","DOI":"10.3389\/fcvm.2015.00031","article-title":"Mitral annular kinetics, left atrial, and left ventricular diastolic function post mitral valve repair in degenerative mitral regurgitation","volume":"2","author":"Schiros","year":"2015","journal-title":"Front. Cardiovasc. Med."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"608","DOI":"10.3349\/ymj.2015.56.3.608","article-title":"Left atrial function following surgical ablation of atrial fibrillation: Prospective evaluation using dual-source cardiac computed tomography","volume":"56","author":"Kim","year":"2015","journal-title":"Yonsei Med. J."},{"key":"ref_34","first-page":"560","article-title":"Limited left atrial surgical ablation effectively treats atrial fibrillation but decreases left atrial function","volume":"19","author":"Compier","year":"2017","journal-title":"Europace"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"2309","DOI":"10.1016\/j.jacc.2017.08.073","article-title":"Recovery of left atrial contractile function after maze surgery in persistent longstanding atrial fibrillation","volume":"70","author":"Thorpe","year":"2017","journal-title":"JACC"},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1016\/j.echo.2018.03.011","article-title":"Left atrial function is associated with earlier need for cardiac surgery in moderate to severe mitral regurgitation: Usefulness in targeting for early surgery","volume":"31","author":"Ring","year":"2018","journal-title":"J. Am. Soc. Echocardiogr."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"3630","DOI":"10.21037\/jtd.2017.09.128","article-title":"Effectiveness of catheter ablation of atrial fibrillation: Are we at the dawn of a new era?","volume":"9","author":"Anselmino","year":"2017","journal-title":"J. Thorac. Dis."}],"container-title":["Medicina"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/10\/709\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T13:28:13Z","timestamp":1760189293000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1648-9144\/55\/10\/709"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2019,10,21]]},"references-count":37,"journal-issue":{"issue":"10","published-online":{"date-parts":[[2019,10]]}},"alternative-id":["medicina55100709"],"URL":"https:\/\/doi.org\/10.3390\/medicina55100709","relation":{},"ISSN":["1648-9144"],"issn-type":[{"type":"electronic","value":"1648-9144"}],"subject":[],"published":{"date-parts":[[2019,10,21]]}}}