Journal of Chest Surgery

The Korean Society for Thoracic and Cardiovascular Surgery (대한심장혈관흉부외과학회)
권호 표지
DOI QR코드

DOI QR Code

Impact of Interatrial Septal Reconstruction on Atrial Tachyarrhythmia after Surgical Resection of Myxoma

  • Mi Young Jang (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Jun Ho Lee (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Muhyung Heo (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Suk Kyung Lim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Su Ryeun Chung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Kiick Sung (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Wook Sung Kim (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine) ;
  • Yang Hyun Cho (Department of Thoracic and Cardiovascular Surgery, Samsung Medical Center, Sungkyunkwan University School of Medicine)
  • Received : 2022.10.12
  • Accepted : 2022.12.22
  • Published : 2023.05.05
Download PDF
⟨ Previous Next ⟩

Abstract

Background: Complete surgical excision is the only curative treatment for primary cardiac tumors. For wide excision, interatrial septal reconstruction (ISR) is commonly performed. We hypothesized that ISR may increase the risk of postoperative atrial tachyarrhythmia (AT) after surgical resection of cardiac myxoma. Methods: After excluding patients with a history of cardiac surgery and concomitant procedures unrelated to tumor resection and those with AT or permanent pacemakers, we finally enrolled 272 adult patients who underwent benign cardiac tumor surgery from 1995 to 2021 at our institution. They were divided into the ISR (n=184) and non-ISR (n=88) groups. The primary outcome was postoperative new-onset AT. Results: The study cohort predominantly consisted of women (66.2%), with a mean age of 57.2±13.6 years. The incidence of postoperative new-onset AT was 15.4%. No 30-day mortality or recurrence was observed. The cardiopulmonary bypass time and aortic cross-clamping time were significantly longer in the ISR group than in the non-ISR group (p<0.001). The median duration of hospital stay of all patients was 6.0 days (interquartile range, 5.0-7.0 days), and no significant difference was observed between the 2 groups (p=0.329). ISR was not an independent predictor of new-onset AT (p=0.248). Male sex and hypertension were found to be independent predictors of new-onset AT. Conclusion: ISR was not a significant predictor of postoperative new-onset AT. ISR might be a feasible and safe procedure for surgical resection of cardiac myxoma and should be considered if needed.

Keywords

Acknowledgement

This work was supported by the Korea Medical Device Development Fund grant funded by the Korea government (the Ministry of Science and ICT, the Ministry of Trade, Industry and Energy, the Ministry of Health & Welfare, and the Ministry of Food and Drug Safety) (Project number: 1711138313, KMDF_PR_20200901_0159).

References

  1. Reynen K. Cardiac myxomas. N Engl J Med 1995;333:1610-7. https://doi.org/10.1056/NEJM199512143332407 
  2. Pacini D, Careddu L, Pantaleo A, et al. Primary benign cardiac tumours: long-term results. Eur J Cardiothorac Surg 2012;41:812-9. https://doi.org/10.1093/ejcts/ezr067 
  3. Lee GD, Lee JW, Jung JS, et al. Clinical experiences for cardiac myxomas. Korean J Thorac Cardiovasc Surg 2008;41:703-9. 
  4. Lee KS, Kim GS, Jung Y, et al. Surgical resection of cardiac myxoma-a 30-year single institutional experience. J Cardiothorac Surg 2017;12:18. https://doi.org/10.1186/s13019-017-0583-7 
  5. Jones DR, Warden HE, Murray GF, et al. Biatrial approach to cardiac myxomas: a 30-year clinical experience. Ann Thorac Surg 1995;59:851-6. https://doi.org/10.1016/0003-4975(95)00064-r 
  6. Bateman TM, Gray RJ, Raymond MJ, Chaux A, Czer LS, Matloff JM. Arrhythmias and conduction disturbances following cardiac operation for the removal of left atrial myxomas. J Thorac Cardiovasc Surg 1983;86:601-7. https://doi.org/10.1016/s0022-5223(19)39129-9 
  7. Echahidi N, Pibarot P, O'Hara G, Mathieu P. Mechanisms, prevention, and treatment of atrial fibrillation after cardiac surgery. J Am Coll Cardiol 2008;51:793-801. https://doi.org/10.1016/j.jacc.2007.10.043 
  8. Taha A, Nielsen SJ, Bergfeldt L, et al. New-onset atrial fibrillation after coronary artery bypass grafting and long-term outcome: a population-based nationwide study from the SWEDEHEART Registry. J Am Heart Assoc 2021;10:e017966. https://doi.org/10.1161/JAHA.120.017966 
  9. Quah JX, Jenkins E, Dharmaprani D, et al. Role of interatrial conduction in atrial fibrillation: mechanistic insights from renewal theory-based fibrillatory dynamic analysis. Heart Rhythm O2 2022;3:335-43. https://doi.org/10.1016/j.hroo.2022.05.007 
  10. Lopez-Candales A, Grewal H, Katz W. The importance of increased interatrial septal thickness in patients with atrial fibrillation: a transesophageal echocardiographic study. Echocardiography 2005;22:408-14. https://doi.org/10.1111/j.1540-8175.2005.04088.x 
  11. Kharbanda RK, Ozdemir EH, Taverne YJ, Kik C, Bogers AJ, de Groot NM. Current concepts of anatomy, electrophysiology, and therapeutic implications of the interatrial septum. JACC Clin Electrophysiol 2019;5:647-56. https://doi.org/10.1016/j.jacep.2019.04.013 
  12. Power DA, Lampert J, Camaj A, et al. Cardiovascular complications of interatrial conduction block: JACC state-of-the-art review. J Am Coll Cardiol 2022;79:1199-211. https://doi.org/10.1016/j.jacc.2022.01.030 
  13. Sahin M, Tigen K, Dundar C, et al. Postoperative atrial fibrillation in patients with left atrial myxoma. Cardiovasc J Afr 2015;26:120-4. https://doi.org/10.5830/CVJA-2014-069 
  14. Garatti A, Nano G, Canziani A, et al. Surgical excision of cardiac myxomas: twenty years experience at a single institution. Ann Thorac Surg 2012;93:825-31. https://doi.org/10.1016/j.athoracsur.2011.11.009 
  15. Lad VS, Jain J, Agarwala S, et al. Right atrial trans-septal approach for left atrial myxomas: nine-year experience. Heart Lung Circ 2006;15:38-43. https://doi.org/10.1016/j.hlc.2005.06.008 
  16. Zakkar M, Ascione R, James AF, Angelini GD, Suleiman MS. Inflammation, oxidative stress and postoperative atrial fibrillation in cardiac surgery. Pharmacol Ther 2015;154:13-20. https://doi.org/10.1016/j.pharmthera.2015.06.009 
  17. Qu C, Wang XW, Huang C, Qiu F, Xiang XY, Lu ZQ. High mobility group box 1 gene polymorphism is associated with the risk of postoperative atrial fibrillation after coronary artery bypass surgery. J Cardiothorac Surg 2015;10:88. https://doi.org/10.1186/s13019-015-0301-2 
  18. Ishii Y, Schuessler RB, Gaynor SL, et al. Inflammation of atrium after cardiac surgery is associated with inhomogeneity of atrial conduction and atrial fibrillation. Circulation 2005;111:2881-8. https://doi.org/10.1161/CIRCULATIONAHA.104.475194 
  19. Mitchell LB; CCS Atrial Fibrillation Guidelines Committee. Canadian Cardiovascular Society atrial fibrillation guidelines 2010: prevention and treatment of atrial fibrillation following cardiac surgery. Can J Cardiol 2011;27:91-7. https://doi.org/10.1016/j.cjca.2010.11.005 
  20. Hashemzadeh K, Dehdilani M, Dehdilani M. Postoperative atrial fibrillation following open cardiac surgery: predisposing factors and complications. J Cardiovasc Thorac Res 2013;5:101-7. https://doi.org/10.5681/jcvtr.2013.022 
  21. Dobrev D, Aguilar M, Heijman J, Guichard JB, Nattel S. Postoperative atrial fibrillation: mechanisms, manifestations and management. Nat Rev Cardiol 2019;16:417-36. https://doi.org/10.1038/s41569-019-0166-5 
  22. LaPar DJ, Speir AM, Crosby IK, et al. Postoperative atrial fibrillation significantly increases mortality, hospital readmission, and hospital costs. Ann Thorac Surg 2014;98:527-33. https://doi.org/10.1016/j.athoracsur.2014.03.039 
  23. Greenberg JW, Lancaster TS, Schuessler RB, Melby SJ. Postoperative atrial fibrillation following cardiac surgery: a persistent complication. Eur J Cardiothorac Surg 2017;52:665-72. https://doi.org/10.1093/ejcts/ezx039 
  24. Melduni RM, Schaff HV, Bailey KR, et al. Implications of new-onset atrial fibrillation after cardiac surgery on long-term prognosis: a community-based study. Am Heart J 2015;170:659-68. https://doi.org/10.1016/j.ahj.2015.06.015 
  25. Lee SH, Kang DR, Uhm JS, et al. New-onset atrial fibrillation predicts long-term newly developed atrial fibrillation after coronary artery bypass graft. Am Heart J 2014;167:593-600. https://doi.org/10.1016/j.ahj.2013.12.010 
  26. Gaudino M, Di Franco A, Rong LQ, et al. Pericardial effusion provoking atrial fibrillation after cardiac surgery: JACC review topic of the week. J Am Coll Cardiol 2022;79:2529-39. https://doi.org/10.1016/j.jacc.2022.04.029 
  27. Jiang CX, Wang JG, Qi RD, et al. Long-term outcome of patients with atrial myxoma after surgical intervention: analysis of 403 cases. J Geriatr Cardiol 2019;16:338-43. https://doi.org/10.11909/j.issn.1671-5411.2019.04.003 
  28. Burrage PS, Low YH, Campbell NG, O'Brien B. New-onset atrial fibrillation in adult patients after cardiac surgery. Curr Anesthesiol Rep 2019;9:174-93. https://doi.org/10.1007/s40140-019-00321-4 
  29. Nair SG. Atrial fibrillation after cardiac surgery. Ann Card Anaesth 2010;13:196-205. https://doi.org/10.4103/0971-9784.69047 
  30. Almassi GH, Schowalter T, Nicolosi AC, et al. Atrial fibrillation after cardiac surgery: a major morbid event? Ann Surg 1997;226:501-13. https://doi.org/10.1097/00000658-199710000-00011