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Background <p>Adjuvant procedures to treat persistent long-standing atrial fibrillation (AF) in patients undergoing mitral valve surgery are known to improve postoperative outcomes. Traditionally, the Cox-Maze operation has had outstanding long-term outcomes, but it is not widely employed because of its intricacy and lengthy learning curve. Pulmonary vein isolation (PVI) using the cut-and-sew technique and excision of the left atrial appendage (LAA) can be a simpler alternative adjuvant procedure in mitral valve surgery patients.</p> Methods <p>A prospective observational study was conducted from January 2020 to December 2024, involving patients requiring mitral valve procedures with persistent long-standing AF on anti-arrhythmic treatment. Adjuvant PVI and LAA excision were carried out in all these patients for treating this AF. The mean follow-up period of the patients was 48.7 ± 7&#xa0;months to assess their return to normal sinus rhythm (NSR).</p> Results <p>This study observed that PVI by cut-and-sew technique achieved NSR in 96.4% at 6&#xa0;months follow-up. A significant mean difference was found between preoperative and postoperative left atrial (LA) diameter of 1.0778 ± 0.3804&#xa0;cm. Re-exploration for bleeding, thromboembolic events, and postoperative anti-arrhythmic drug requirement or permanent pacemaker implantation were nil.</p> Conclusion <p>The cut-and-sew PVI with LAA excision is a safe, effective, and cost-efficient technique for AF treatment in mitral valve surgery. It creates a transmural lesion that forms a scar and is a permanent, reliable stopgap for ectopic electrical impulses. Our findings support its feasibility, especially in resource-limited settings, though larger studies are needed for further validation.</p> Graphical Abstract <p></p>

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Revisiting the cut-and-sew technique for pulmonary vein isolation and LAA excision to treat long-standing persistent atrial fibrillation in mitral valve surgery

  • 期刊论文

  • 发表日期：

    2025年12月1日

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  • Bhargavi Gande,
  • Madhuprakash Chikkamadegowda Sorekaidoddi,
  • Kumar Pathakota,
  • Vinayaka Shivananda Chatram,
  • Jayaprakash Mahadevaiah Hemmargala

摘要

Background

Adjuvant procedures to treat persistent long-standing atrial fibrillation (AF) in patients undergoing mitral valve surgery are known to improve postoperative outcomes. Traditionally, the Cox-Maze operation has had outstanding long-term outcomes, but it is not widely employed because of its intricacy and lengthy learning curve. Pulmonary vein isolation (PVI) using the cut-and-sew technique and excision of the left atrial appendage (LAA) can be a simpler alternative adjuvant procedure in mitral valve surgery patients.

Methods

A prospective observational study was conducted from January 2020 to December 2024, involving patients requiring mitral valve procedures with persistent long-standing AF on anti-arrhythmic treatment. Adjuvant PVI and LAA excision were carried out in all these patients for treating this AF. The mean follow-up period of the patients was 48.7 ± 7 months to assess their return to normal sinus rhythm (NSR).

Results

This study observed that PVI by cut-and-sew technique achieved NSR in 96.4% at 6 months follow-up. A significant mean difference was found between preoperative and postoperative left atrial (LA) diameter of 1.0778 ± 0.3804 cm. Re-exploration for bleeding, thromboembolic events, and postoperative anti-arrhythmic drug requirement or permanent pacemaker implantation were nil.

Conclusion

The cut-and-sew PVI with LAA excision is a safe, effective, and cost-efficient technique for AF treatment in mitral valve surgery. It creates a transmural lesion that forms a scar and is a permanent, reliable stopgap for ectopic electrical impulses. Our findings support its feasibility, especially in resource-limited settings, though larger studies are needed for further validation.

Graphical Abstract